Provider Demographics
NPI:1881132777
Name:FIALLOS-DIAZ, EVA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:EVA
Middle Name:
Last Name:FIALLOS-DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:CABALLERO DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1820 E PARK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2873
Mailing Address - Country:US
Mailing Address - Phone:850-297-2000
Mailing Address - Fax:
Practice Address - Street 1:1820 E PARK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-2873
Practice Address - Country:US
Practice Address - Phone:850-297-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 126841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical