MEDICARE: DORKA MARIE DIAZ MSW

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	1041C0700X	Clinical Social Worker	11001	CT

General Provider Information

NPI Number	:	1669367512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORKA MARIE DIAZ MSW

Provider Business Mailing Address
First Line	:	31 GRANT ST
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-4108
Country	:	US
Telephone Number	:	860-839-0099
Fax Number	:

Provider Business Practice Location Address
First Line	:	136 BARTHOLOMEW AVE
Second Line	:
City	:	HARTFORD
State	:	CT
Zip	:	06106-2901
Country	:	US
Telephone Number	:	860-839-0099
Fax Number	:

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

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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