Provider Demographics
NPI:1003557000
Name:DIAZ, ROBERT (MA, CADC, CRS, CFRS,)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MA, CADC, CRS, CFRS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-0034
Mailing Address - Country:US
Mailing Address - Phone:484-525-9832
Mailing Address - Fax:
Practice Address - Street 1:1262 WOOD LN STE 102
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-4250
Practice Address - Country:US
Practice Address - Phone:267-358-5150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)