Provider Demographics
NPI:1649615246
Name:DIAZ, MELISSA (MS)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ELLA ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1808
Mailing Address - Country:US
Mailing Address - Phone:412-716-8526
Mailing Address - Fax:
Practice Address - Street 1:70 W BEAVER ST
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1582
Practice Address - Country:US
Practice Address - Phone:724-452-4453
Practice Address - Fax:724-452-6576
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional