Provider Demographics
NPI:1114582624
Name:DIAZ, VANIA
Entity Type:Individual
Prefix:
First Name:VANIA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VANIA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:65 QUEENS WAY APT 6
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7744
Mailing Address - Country:US
Mailing Address - Phone:773-892-8559
Mailing Address - Fax:773-892-8559
Practice Address - Street 1:300 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHMAN
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-879-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health