Provider Demographics
NPI:1558879445
Name:DIAZ, ROMAIN NICOLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROMAIN
Middle Name:NICOLE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 ATWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3308
Mailing Address - Country:US
Mailing Address - Phone:215-914-5797
Mailing Address - Fax:
Practice Address - Street 1:377 E UPSAL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2348
Practice Address - Country:US
Practice Address - Phone:215-914-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-13
Last Update Date:2018-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC009889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional