Provider Demographics
NPI:1104135094
Name:DIAZ, LUCIA LEO- (LCSW)
Entity type:Individual
Prefix:MS
First Name:LUCIA
Middle Name:LEO-
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N DUNLAP AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3933
Mailing Address - Country:US
Mailing Address - Phone:956-222-3552
Mailing Address - Fax:956-585-8984
Practice Address - Street 1:1200 N DUNLAP AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3933
Practice Address - Country:US
Practice Address - Phone:956-222-3552
Practice Address - Fax:956-585-8984
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX172841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical