Provider Demographics
NPI:1801830930
Name:DIAZ, ANELE (PSYD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:ANELE
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14221 SW 120TH ST STE 121
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7463
Mailing Address - Country:US
Mailing Address - Phone:786-359-4818
Mailing Address - Fax:786-353-2918
Practice Address - Street 1:14221 SW 120TH ST STE 121
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7463
Practice Address - Country:US
Practice Address - Phone:786-359-4818
Practice Address - Fax:786-353-2918
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10686101YM0800X
103K00000X
FLPY9578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL765569000Medicaid
FL003702100Medicaid