Provider Demographics
NPI:1134751514
Name:DIAZ-TORO, ADOLFO SANTISIMA (MA CMHC, CASAC T)
Entity type:Individual
Prefix:
First Name:ADOLFO
Middle Name:SANTISIMA
Last Name:DIAZ-TORO
Suffix:
Gender:M
Credentials:MA CMHC, CASAC T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11104-2406
Mailing Address - Country:US
Mailing Address - Phone:718-706-1663
Mailing Address - Fax:718-672-2027
Practice Address - Street 1:4404 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11104-2406
Practice Address - Country:US
Practice Address - Phone:718-706-1663
Practice Address - Fax:718-672-2127
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty