Provider Demographics
NPI:1952841397
Name:DIAZ, JUAN CARLOS (CASAC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:CARLOS
Last Name:DIAZ
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7746
Mailing Address - Country:US
Mailing Address - Phone:516-902-4629
Mailing Address - Fax:718-264-4188
Practice Address - Street 1:33 GUY LOMBARDO AVE
Practice Address - Street 2:H.E.L.P. SERVICES
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3637
Practice Address - Country:US
Practice Address - Phone:516-546-2822
Practice Address - Fax:516-546-5051
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24671101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)