Provider Demographics
NPI:1760752711
Name:DIAZ, CLUNY R (RCSWI)
Entity Type:Individual
Prefix:MRS
First Name:CLUNY
Middle Name:R
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RCSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7852 NW 164TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-8412
Mailing Address - Country:US
Mailing Address - Phone:954-682-0255
Mailing Address - Fax:
Practice Address - Street 1:17501 SW 117TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-2272
Practice Address - Country:US
Practice Address - Phone:305-254-9759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW 47351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical