Provider Demographics
NPI:1821221441
Name:DIAZ-POORE, ANNA JULIET (LPCF)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:JULIET
Last Name:DIAZ-POORE
Suffix:
Gender:F
Credentials:LPCF
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:DIAZ-POORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:614 N EASTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4301
Mailing Address - Country:US
Mailing Address - Phone:215-884-9770
Mailing Address - Fax:215-884-6130
Practice Address - Street 1:614 N EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4301
Practice Address - Country:US
Practice Address - Phone:215-884-9770
Practice Address - Fax:215-884-6130
Is Sole Proprietor?:No
Enumeration Date:2009-08-30
Last Update Date:2009-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PAPC003405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)