Provider Demographics
NPI:1952455339
Name:DIAZ, LOUIS A (LCSW)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 ALTA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1315
Mailing Address - Country:US
Mailing Address - Phone:415-388-4318
Mailing Address - Fax:
Practice Address - Street 1:1420 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5223
Practice Address - Country:US
Practice Address - Phone:925-646-5480
Practice Address - Fax:925-646-5754
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6019OtherLCSW