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General NPI Number Information
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NPI Number | 1033679592
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Entity Type | Individual
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Provider Name | ALEJANDRO DIAZ PHD, LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 68 MAIN ST SUITE 340
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City | TUCKAHOE
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State | NY
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Zip | 10707
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Country | US
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Telephone | 914-793-9719
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Fax |
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Provider Business Mailing Address
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Address Line | 25 GREENFIELD AVE
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City | BRONXVILLE
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State | NY
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Zip | 10708-2501
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Country | US
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Telephone | 914-793-9719
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 062358
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License Number State | NY
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