Provider Demographics
NPI:1477626844
Name:ALEX DIAZ, LCSW, P.C.
Entity Type:Organization
Organization Name:ALEX DIAZ, LCSW, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:914-793-9719
Mailing Address - Street 1:25 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-2501
Mailing Address - Country:US
Mailing Address - Phone:914-793-9719
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:ROOM # 101
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2908
Practice Address - Country:US
Practice Address - Phone:914-793-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR 062358-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
523977Medicare UPIN
252449998Medicare UPIN
1035180Medicare UPIN