Provider Demographics
NPI:1215398805
Name:DIAZ, LEONOR
Entity Type:Individual
Prefix:
First Name:LEONOR
Middle Name:
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 1:26 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1602
Mailing Address - Country:US
Mailing Address - Phone:212-942-8500
Mailing Address - Fax:212-567-2019
Practice Address - Street 1:26 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1602
Practice Address - Country:US
Practice Address - Phone:212-942-8500
Practice Address - Fax:212-567-2019
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health