Provider Demographics
NPI:1922500941
Name:DIAZ-RICHARDSON, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:DIAZ-RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 GLOUCESTER CT
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34758-2608
Mailing Address - Country:US
Mailing Address - Phone:407-501-0996
Mailing Address - Fax:
Practice Address - Street 1:1028 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1607
Practice Address - Country:US
Practice Address - Phone:407-930-4802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health