Provider Demographics
NPI:1013221241
Name:DYJAK DIAZ, DEBORAH (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DYJAK DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5134 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77807-7678
Mailing Address - Country:US
Mailing Address - Phone:832-231-1757
Mailing Address - Fax:
Practice Address - Street 1:2700 E 29TH ST STE 325
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2588
Practice Address - Country:US
Practice Address - Phone:979-704-6509
Practice Address - Fax:979-821-7372
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical