Provider Demographics
NPI:1104101427
Name:PAULA DIAZ COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:PAULA DIAZ COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-420-7646
Mailing Address - Street 1:223 BLOOMFIELD ST
Mailing Address - Street 2:SUITE # 121
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4747
Mailing Address - Country:US
Mailing Address - Phone:201-420-7646
Mailing Address - Fax:201-420-7647
Practice Address - Street 1:223 BLOOMFIELD ST
Practice Address - Street 2:SUITE # 121
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-4747
Practice Address - Country:US
Practice Address - Phone:201-420-7646
Practice Address - Fax:201-420-7647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05219700251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health