Provider Demographics
NPI:1033679592
Name:DIAZ, ALEJANDRO (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LCSW
Mailing Address - Street 1:25 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2501
Mailing Address - Country:US
Mailing Address - Phone:914-793-9719
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707
Practice Address - Country:US
Practice Address - Phone:914-793-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1035180OtherBEACON HEALTH
NY523977OtherVALUE OPTIONS
NYBORITOOtherOPTUM