Provider Demographics
NPI:1366644395
Name:DIAS, VICTOR S
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:S
Last Name:DIAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:492 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-2208
Mailing Address - Country:US
Mailing Address - Phone:508-672-6077
Mailing Address - Fax:
Practice Address - Street 1:400 NATHAN ELLIS HWY
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3143
Practice Address - Country:US
Practice Address - Phone:508-477-5488
Practice Address - Fax:508-477-9334
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MANONE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker