Provider Demographics
NPI:1407093339
Name:DIAZ, EVELYN DELCARMEN
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DELCARMEN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 PERKINS AVE UNIT 2-3
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-1979
Mailing Address - Country:US
Mailing Address - Phone:203-528-7220
Mailing Address - Fax:
Practice Address - Street 1:488 PERKINS AVE UNIT 2-3
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-1979
Practice Address - Country:US
Practice Address - Phone:203-528-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker