Provider Demographics
NPI:1164078473
Name:DIAZ, VANESA (LMSW)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:
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 1:1000 HOWARD AVE STE 229
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70113-1903
Mailing Address - Country:US
Mailing Address - Phone:504-310-6933
Mailing Address - Fax:
Practice Address - Street 1:4200 S I 10 SERVICE RD W STE 110
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1237
Practice Address - Country:US
Practice Address - Phone:504-310-6984
Practice Address - Fax:504-523-2789
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker