Provider Demographics
NPI:1952747461
Name:ALBA, RENALDO DIAZ (MSED)
Entity type:Individual
Prefix:MR
First Name:RENALDO
Middle Name:DIAZ
Last Name:ALBA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2994 OTIS AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2138
Mailing Address - Country:US
Mailing Address - Phone:917-583-3698
Mailing Address - Fax:347-621-4718
Practice Address - Street 1:15 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2924
Practice Address - Country:US
Practice Address - Phone:845-219-1637
Practice Address - Fax:845-480-5423
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health