Provider Demographics
NPI:1154037380
Name:CORDOVA-DIAZ, ANAIS (LPC)
Entity type:Individual
Prefix:
First Name:ANAIS
Middle Name:
Last Name:CORDOVA-DIAZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANS SOUCI B28 CALLE 13
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957-4336
Mailing Address - Country:US
Mailing Address - Phone:787-378-0708
Mailing Address - Fax:
Practice Address - Street 1:URB. SANS SOUCI B28 CALLE 13
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-4336
Practice Address - Country:US
Practice Address - Phone:787-378-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR002933101YP2500X
TX79653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional