Provider Demographics
NPI:1104093905
Name:DIAZ, LAZARO (LCSW)
Entity type:Individual
Prefix:
First Name:LAZARO
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 SW 6TH ST APT 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-2626
Mailing Address - Country:US
Mailing Address - Phone:786-380-6496
Mailing Address - Fax:
Practice Address - Street 1:755 SW 6TH ST APT 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2626
Practice Address - Country:US
Practice Address - Phone:786-380-6496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW138691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical