Provider Demographics
NPI:1801142799
Name:DIAZ-LA CILENTO, AIDA IRIS (LPC)
Entity type:Individual
Prefix:
First Name:AIDA
Middle Name:IRIS
Last Name:DIAZ-LA CILENTO
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:IRIS
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:114 W MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-4223
Mailing Address - Country:US
Mailing Address - Phone:860-803-3143
Mailing Address - Fax:860-271-8312
Practice Address - Street 1:114 W MAIN ST STE 302
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-4223
Practice Address - Country:US
Practice Address - Phone:860-390-1383
Practice Address - Fax:860-271-8312
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT002692101YP2500X
CT2692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health