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General NPI Number Information
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NPI Number | 1629708961
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Entity Type | Individual
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Provider Name | ULYSSES DIAZ
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Gender | Male
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 28175 HAGGERTY RD
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City | NOVI
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State | MI
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Zip | 48377-2903
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Country | US
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Telephone | 248-665-8115
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Fax |
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Provider Business Mailing Address
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Address Line | 2854 KALMIA AVE APT 201
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City | BOULDER
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State | CO
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Zip | 80301-5908
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Country | US
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Telephone | 630-870-2856
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW.09928144
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801114812
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License Number State | MI
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