Provider Demographics
NPI:1184084758
Name:DIAZ, VIRGINIA ANGELES (LICSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANGELES
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 LINDEN BLVD
Mailing Address - Street 2:4B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3470
Mailing Address - Country:US
Mailing Address - Phone:206-310-5485
Mailing Address - Fax:
Practice Address - Street 1:1715 C ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4016
Practice Address - Country:US
Practice Address - Phone:206-310-5485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088326-1104100000X
WA606064521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker