MEDICARE: MRS. ELIZABETH ROQUE-DIAZ LCSW

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	04906	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679511018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ROQUE-DIAZ LCSW

Provider Business Mailing Address
First Line	:	8930 FOURWINDS DR
Second Line	:	STE 335
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-618-7249
Fax Number	:	210-590-0355

Provider Business Practice Location Address
First Line	:	8930 FOURWINDS DR
Second Line	:	STE 335
City	:	WINDCREST
State	:	TX
Zip	:	78239-1970
Country	:	US
Telephone Number	:	210-618-7249
Fax Number	:	210-590-0355

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

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/04/2014

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