Provider Demographics
NPI:1093497737
Name:DIAZ, ASHLEY PENNY
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:PENNY
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W 147TH ST APT 16H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4340
Mailing Address - Country:US
Mailing Address - Phone:718-902-0006
Mailing Address - Fax:
Practice Address - Street 1:129 W 147TH ST APT 16H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4340
Practice Address - Country:US
Practice Address - Phone:718-902-0006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116459104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker