Provider Demographics
NPI:1023261583
Name:DIAZ, CANDIDA ROSA (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:CANDIDA
Middle Name:ROSA
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 SOMMERVILLE PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2212
Mailing Address - Country:US
Mailing Address - Phone:914-969-0186
Mailing Address - Fax:
Practice Address - Street 1:289 SOMMERVILLE PL
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2212
Practice Address - Country:US
Practice Address - Phone:914-969-0186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR058985171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor