Provider Demographics
NPI:1891144200
Name:DIAZ, MORAIMA (MSED)
Entity Type:Individual
Prefix:MS
First Name:MORAIMA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7721 31ST AVE
Mailing Address - Street 2:APT. BSMT
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1815
Mailing Address - Country:US
Mailing Address - Phone:917-202-1107
Mailing Address - Fax:
Practice Address - Street 1:7721 31ST AVE
Practice Address - Street 2:APT. BSMT
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1815
Practice Address - Country:US
Practice Address - Phone:917-202-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health