Provider Demographics
NPI:1952664864
Name:DIAZ, VERONICA (MSW)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
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 1:19 AVE LAS MANSIONES
Mailing Address - Street 2:MANSIONES DE SAN MARTIN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-4588
Mailing Address - Country:US
Mailing Address - Phone:787-505-4420
Mailing Address - Fax:
Practice Address - Street 1:19 AVE LAS MANSIONES
Practice Address - Street 2:MANSIONES DE SAN MARTIN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-4588
Practice Address - Country:US
Practice Address - Phone:787-505-4420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11190104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker