Provider Demographics
NPI:1558149849
Name:DIAZ BAEZ, CARLA JANISSE (BS)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:JANISSE
Last Name:DIAZ BAEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3476 ARNEL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2004
Mailing Address - Country:US
Mailing Address - Phone:407-591-9533
Mailing Address - Fax:
Practice Address - Street 1:3476 ARNEL DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2004
Practice Address - Country:US
Practice Address - Phone:407-591-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health