Provider Demographics
NPI:1437287166
Name:DIAZ, SANDRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
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 1:90 NEW STATE HWY, RTE 44
Mailing Address - Street 2:DCS MENTAL HEALTH, INC.
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767
Mailing Address - Country:US
Mailing Address - Phone:508-880-6868
Mailing Address - Fax:
Practice Address - Street 1:90 NEW STATE HWY, RTE 44
Practice Address - Street 2:DCS MENTAL HEALTH, INC.
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767
Practice Address - Country:US
Practice Address - Phone:508-880-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical