Provider Demographics
NPI:1306642434
Name:DIAZ, CARMEN J (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:J
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 JOSLEN BLVD APT 125C
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1040
Mailing Address - Country:US
Mailing Address - Phone:917-673-5160
Mailing Address - Fax:
Practice Address - Street 1:540 JOSLEN BLVD APT 125C
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1040
Practice Address - Country:US
Practice Address - Phone:917-673-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108909104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker