Provider Demographics
NPI:1013733187
Name:DIAZ, SAMARA L (RMFT)
Entity type:Individual
Prefix:MS
First Name:SAMARA
Middle Name:L
Last Name:DIAZ
Suffix:
Gender:F
Credentials:RMFT
Other - Prefix:MS
Other - First Name:SAMARA
Other - Middle Name:LORIS
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RMFT
Mailing Address - Street 1:12608 NW 98TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7416
Mailing Address - Country:US
Mailing Address - Phone:786-925-5111
Mailing Address - Fax:
Practice Address - Street 1:2731 EXECUTIVE PARK DR STE 9
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3659
Practice Address - Country:US
Practice Address - Phone:754-272-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist