Provider Demographics
NPI:1346550050
Name:DIAZ, STEVEN SR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:DIAZ
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 MAIN ST APT 324
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-4039
Mailing Address - Country:US
Mailing Address - Phone:203-565-4492
Mailing Address - Fax:203-345-3331
Practice Address - Street 1:1000 LAFAYETTE BLVD FL 11
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4725
Practice Address - Country:US
Practice Address - Phone:860-922-5034
Practice Address - Fax:203-345-3331
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000887101YA0400X
CT115661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)