Provider Demographics
NPI:1811103351
Name:DIAZ, ALEXIS (LMHC, CBHCMS, ITDS)
Entity type:Individual
Prefix:MR
First Name:ALEXIS
Middle Name:
Last Name:DIAZ
Suffix:
Gender:
Credentials:LMHC, CBHCMS, ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 MADRUGA AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3048
Mailing Address - Country:US
Mailing Address - Phone:786-536-9714
Mailing Address - Fax:786-536-9833
Practice Address - Street 1:1550 MADRUGA AVE STE 509
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-3048
Practice Address - Country:US
Practice Address - Phone:786-536-9714
Practice Address - Fax:786-536-9833
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 222Q00000X
FLMH25016101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022190700Medicaid
FL125643500Medicaid