Provider Demographics
NPI:1396817904
Name:DIAZ, NADIA MACARENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:MACARENA
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 1:10460 QUEENS BLVD APT 12W
Mailing Address - Street 2:APT 12W
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7342
Mailing Address - Country:US
Mailing Address - Phone:718-896-4370
Mailing Address - Fax:718-896-4370
Practice Address - Street 1:7158 AUSTIN ST STE 208
Practice Address - Street 2:APT 12W
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4715
Practice Address - Country:US
Practice Address - Phone:917-562-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638324Medicaid
NY02638324Medicaid
NYQ45128Medicare UPIN