Provider Demographics
NPI:1235446741
Name:DIAK, WALTER FRANCIS III (PHD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FRANCIS
Last Name:DIAK
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:WALTER
Other - Middle Name:F
Other - Last Name:DIAK III
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:28870 US 19 N
Mailing Address - Street 2:SUITE 357
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2596
Mailing Address - Country:US
Mailing Address - Phone:727-280-6569
Mailing Address - Fax:
Practice Address - Street 1:28870 US 19 N
Practice Address - Street 2:SUITE 357
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2596
Practice Address - Country:US
Practice Address - Phone:727-280-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8129103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEB760AMedicare PIN