Provider Demographics
NPI:1023326204
Name:DAZA, ADRIANA CAROLINA (MS)
Entity type:Individual
Prefix:MS
First Name:ADRIANA
Middle Name:CAROLINA
Last Name:DAZA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 MAIN ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6324
Mailing Address - Country:US
Mailing Address - Phone:914-355-2440
Mailing Address - Fax:
Practice Address - Street 1:481 MAIN ST
Practice Address - Street 2:SUITE 401
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-6324
Practice Address - Country:US
Practice Address - Phone:914-355-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP77753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health