Doctor Name: | TOMAS DIAZ |
NPI Number: | 1023498664 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MHS, LCADC |
License Number: | 37LC00156200 |
Business Practice Address: | 220 Market St Perth Amboy, NJ - 088614331 |
Business Phone Number: | 7327097440 |
Business Fax Number: | 7327090147 |
Mailing Address: | 220 Market St, PERTH AMBOY |
State: | NJ |
Postal Code: | 088614331 |
Phone Number: | 7327097440 |
Fax Number: | 7327090147 |
NPI Enumeration Date: | 06/08/2015 |
NPI Last Update Date: | 06/08/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 37LC00156200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |