Provider Demographics
NPI:1790447662
Name:DIAZ, VERONICA MELANIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:MELANIE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 WESTLAKE DR APT 405
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6442
Mailing Address - Country:US
Mailing Address - Phone:240-676-9761
Mailing Address - Fax:
Practice Address - Street 1:20410 OBSERVATION DR STE 108
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6419
Practice Address - Country:US
Practice Address - Phone:240-296-5862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker