Provider Demographics
NPI:1679651996
Name:DIAZ, INGRID (PHD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PARK SQ
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1878
Mailing Address - Country:US
Mailing Address - Phone:732-718-4873
Mailing Address - Fax:
Practice Address - Street 1:3 PARK SQ
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1878
Practice Address - Country:US
Practice Address - Phone:732-718-4873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY11025103TC0700X
NY023959-01103TC0700X
NJ44SC052269001041C0700X
FLSW128021041C0700X
NJ35S100619800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
086647PSYMedicare ID - Type Unspecified