Provider Demographics
NPI:1235743782
Name:DIEZ, BEATRIZ M (RCMHC)
Entity Type:Individual
Prefix:
First Name:BEATRIZ
Middle Name:M
Last Name:DIEZ
Suffix:
Gender:F
Credentials:RCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 OAK HAMMOCK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7814
Mailing Address - Country:US
Mailing Address - Phone:786-516-0814
Mailing Address - Fax:813-354-4606
Practice Address - Street 1:3904 OAK HAMMOCK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7814
Practice Address - Country:US
Practice Address - Phone:786-516-0814
Practice Address - Fax:813-354-4606
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19855101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty