Provider Demographics
NPI:1508649708
Name:DIAZ, BRIANNA MARIA (PSYD)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1965
Mailing Address - Country:US
Mailing Address - Phone:585-315-6367
Mailing Address - Fax:
Practice Address - Street 1:3900 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1965
Practice Address - Country:US
Practice Address - Phone:585-315-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025842-01103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical