Provider Demographics
NPI:1336295534
Name:DIAZ, JOSEPHINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 CENTRAL PARK W
Mailing Address - Street 2:SUITE #6E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6054
Mailing Address - Country:US
Mailing Address - Phone:212-665-5716
Mailing Address - Fax:212-665-5716
Practice Address - Street 1:382 CENTRAL PARK W
Practice Address - Street 2:SUITE #6E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6054
Practice Address - Country:US
Practice Address - Phone:212-665-5716
Practice Address - Fax:212-665-5716
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012503-1103TC0700X
NY026072-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402493OtherGHI
NY01773720Medicaid
NY179197OtherMHN
NY7402493OtherGHI
NY179197OtherMHN