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NPI Code Detail

MEDICARE: ANNA JULIET DIAZ-POORE LPCF

MEDICARE: ANNA JULIET DIAZ-POORE LPCF
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health CounselorPC003405PA

General Provider Information

NPI Number : 1821221441
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA JULIET DIAZ-POORE LPCF
Provider Business Mailing Address
First Line : 614 N EASTON RD
Second Line :
City : GLENSIDE
State : PA
Zip : 19038-4301
Country : US
Telephone Number : 215-884-9770
Fax Number : 215-884-6130
Provider Business Practice Location Address
First Line : 614 N EASTON RD
Second Line :
City : GLENSIDE
State : PA
Zip : 19038-4301
Country : US
Telephone Number : 215-884-9770
Fax Number : 215-884-6130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2009
Last Update Date : 08/30/2009

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Directions to “ ANNA JULIET DIAZ-POORE LPCF” Practice Location

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