Provider Demographics
NPI:1134705247
Name:DIAZ, ELMER (LICENSED SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LICENSED SOCIAL WORK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 33RD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-1304
Mailing Address - Country:US
Mailing Address - Phone:202-716-7456
Mailing Address - Fax:
Practice Address - Street 1:117 33RD ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1304
Practice Address - Country:US
Practice Address - Phone:202-716-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50082933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker