Provider Demographics
NPI:1154954899
Name:DIAZ, DAVID (LMSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DIAZ
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7209 SANDOVAL DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76131-2528
Mailing Address - Country:US
Mailing Address - Phone:847-828-0860
Mailing Address - Fax:
Practice Address - Street 1:1500 NORWOOD DR
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3651
Practice Address - Country:US
Practice Address - Phone:817-282-3323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69085104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker