Provider Demographics
NPI:1255119616
Name:DIAZ, BYSMEL SARAI
Entity type:Individual
Prefix:
First Name:BYSMEL
Middle Name:SARAI
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BYSMEL
Other - Middle Name:S
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:869 MAIN ST STE 6B
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2985
Mailing Address - Country:US
Mailing Address - Phone:508-794-5188
Mailing Address - Fax:
Practice Address - Street 1:869 MAIN ST STE 6B
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2985
Practice Address - Country:US
Practice Address - Phone:508-794-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health