Provider Demographics
NPI:1679129498
Name:DIAZ, AMY (MA, LIFE COACH)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA, LIFE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1462
Mailing Address - Country:US
Mailing Address - Phone:814-371-4361
Mailing Address - Fax:814-371-4360
Practice Address - Street 1:108 DAVID LN
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-1503
Practice Address - Country:US
Practice Address - Phone:814-590-7885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker