Provider Demographics
NPI:1811515588
Name:DIAZ, NEYSSA L (MA)
Entity type:Individual
Prefix:
First Name:NEYSSA
Middle Name:L
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:R134 CALLE 23
Mailing Address - Street 2:URB. BELLA VISTA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-226-7253
Mailing Address - Fax:
Practice Address - Street 1:AVE. FERNANDEZ JUNCOS 1306
Practice Address - Street 2:PRDA. 19
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00908
Practice Address - Country:US
Practice Address - Phone:787-480-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4103103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling