Provider Demographics
NPI:1760107999
Name:DIAZ, RAMON JR (MA)
Entity Type:Individual
Prefix:MR
First Name:RAMON
Middle Name:
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 W SHERRILL RD
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-9149
Mailing Address - Country:US
Mailing Address - Phone:815-216-8781
Mailing Address - Fax:
Practice Address - Street 1:2175 W SHERRILL RD
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-9149
Practice Address - Country:US
Practice Address - Phone:815-216-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty