Provider Demographics
NPI:1568015725
Name:ESTRADA, DIANA GUADALUPE
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:GUADALUPE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PARKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01835-8514
Mailing Address - Country:US
Mailing Address - Phone:978-587-6543
Mailing Address - Fax:
Practice Address - Street 1:26 PARKRIDGE RD STE 2B
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01835-8515
Practice Address - Country:US
Practice Address - Phone:978-373-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-17
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty