MEDICARE: ROMAIN NICOLE DIAZ MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC009889	PA

General Provider Information

NPI Number	:	1558879445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAIN NICOLE DIAZ MA, LPC

Provider Business Mailing Address
First Line	:	920 ATWOOD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3308
Country	:	US
Telephone Number	:	215-914-5797
Fax Number	:

Provider Business Practice Location Address
First Line	:	377 E UPSAL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-2348
Country	:	US
Telephone Number	:	215-914-5797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2018
Last Update Date	:	01/13/2018

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