Provider Demographics
NPI:1003067711
Name:DIAS, OSVAIL L
Entity Type:Individual
Prefix:MR
First Name:OSVAIL
Middle Name:L
Last Name:DIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 BOUGAINVILLA DR
Mailing Address - Street 2:APT. 111
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5415
Mailing Address - Country:US
Mailing Address - Phone:617-910-7034
Mailing Address - Fax:
Practice Address - Street 1:218 COMMERCIAL BLVD
Practice Address - Street 2:SUITE 232
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-4451
Practice Address - Country:US
Practice Address - Phone:617-910-7034
Practice Address - Fax:954-492-0334
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 142731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical