Provider Demographics
NPI:1033450002
Name:DIAZ, WENDY ANGELICA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANGELICA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 NOSTRAND AVE
Mailing Address - Street 2:APT 5X
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-1478
Mailing Address - Country:US
Mailing Address - Phone:347-542-0852
Mailing Address - Fax:
Practice Address - Street 1:260 BROADWAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8433
Practice Address - Country:US
Practice Address - Phone:347-505-5120
Practice Address - Fax:718-388-0896
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP85830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker