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General NPI Number Information
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NPI Number | 1033450002
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Entity Type | Individual
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Provider Name | WENDY ANGELICA DIAZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/15/2013
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Last Update Date | 03/15/2013
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Provider Practice Location Address
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Address Line | 260 BROADWAY 4TH FLOOR
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City | BROOKLYN
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State | NY
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Zip | 11211-8433
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Country | US
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Telephone | 347-505-5120
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Fax | 718-388-0896
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Provider Business Mailing Address
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Address Line | 390 NOSTRAND AVE APT 5X
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City | BROOKLYN
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State | NY
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Zip | 11216-1478
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Country | US
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Telephone | 347-542-0852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P85830
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License Number State | NY
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