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General NPI Number Information
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NPI Number | 1235446741
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Entity Type | Individual
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Provider Name | WALTER FRANCIS DIAK III PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 28870 US 19 N SUITE 357
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City | CLEARWATER
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State | FL
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Zip | 33761-2596
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Country | US
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Telephone | 727-280-6569
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Fax |
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Provider Business Mailing Address
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Address Line | 28870 US 19 N SUITE 357
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City | CLEARWATER
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State | FL
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Zip | 33761-2596
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Country | US
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Telephone | 727-280-6569
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PY 8129
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License Number State | FL
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