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General NPI Number Information
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NPI Number | 1396817904
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Entity Type | Individual
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Provider Name | NADIA MACARENA DIAZ PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7158 AUSTIN ST STE 208 APT 12W
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City | FOREST HILLS
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State | NY
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Zip | 11375-4715
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Country | US
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Telephone | 917-562-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 10460 QUEENS BLVD APT 12W APT 12W
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City | FOREST HILLS
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State | NY
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Zip | 11375-7342
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Country | US
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Telephone | 718-896-4370
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Fax | 718-896-4370
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016264
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License Number State | NY
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