Provider Demographics
NPI:1336305598
Name:DIAZ, LYDIA ESTHER (LMSW)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:ESTHER
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:ROSENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12472-0454
Mailing Address - Country:US
Mailing Address - Phone:845-313-4364
Mailing Address - Fax:
Practice Address - Street 1:682 ROUTE 213
Practice Address - Street 2:
Practice Address - City:ROSENDALE
Practice Address - State:NY
Practice Address - Zip Code:12472-9763
Practice Address - Country:US
Practice Address - Phone:845-658-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053852104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker