Provider Demographics
NPI:1891989588
Name:DIAZ, TRACEE LYNN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:TRACEE
Middle Name:LYNN
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 NW PLEASANT GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3584
Mailing Address - Country:US
Mailing Address - Phone:772-879-0018
Mailing Address - Fax:772-879-0018
Practice Address - Street 1:214 NW PLEASANT GROVE WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3584
Practice Address - Country:US
Practice Address - Phone:772-879-0018
Practice Address - Fax:772-879-0018
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health