Provider Demographics
NPI:1477807154
Name:DAZA, DIANNE A (MSW)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:A
Last Name:DAZA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4744 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1977
Mailing Address - Country:US
Mailing Address - Phone:407-247-9328
Mailing Address - Fax:
Practice Address - Street 1:4744 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1977
Practice Address - Country:US
Practice Address - Phone:407-247-9328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker