Provider Demographics
NPI:1952970741
Name:WINDSOR DIAZ, JACLYN MICHELLE (MSW, LMSW)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:MICHELLE
Last Name:WINDSOR DIAZ
Suffix:
Gender:F
Credentials:MSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W LIBERTY ST STE 102
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-2019
Mailing Address - Country:US
Mailing Address - Phone:775-525-8103
Mailing Address - Fax:775-525-8105
Practice Address - Street 1:2655 ENTERPRISE RD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1666
Practice Address - Country:US
Practice Address - Phone:775-688-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-2086104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker