Provider Demographics
NPI:1134842180
Name:CASTINEIRA DIAZ, MARYLIEN (CBHCM)
Entity type:Individual
Prefix:
First Name:MARYLIEN
Middle Name:
Last Name:CASTINEIRA DIAZ
Suffix:
Gender:F
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 W FLAGLER ST APT 1105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-1592
Mailing Address - Country:US
Mailing Address - Phone:786-542-4078
Mailing Address - Fax:305-603-8705
Practice Address - Street 1:340 W FLAGLER ST APT 1105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-1592
Practice Address - Country:US
Practice Address - Phone:786-542-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCBHCM104026OtherFLORIDA CERTIFICATION BOARD
FLCBHCM104026OtherFLORIDA CERTIFICATION BOARD