Provider Demographics
NPI:1528121878
Name:DIAZ, ABRAHAM CRUZ JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:CRUZ
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10315 PARKVIEW MOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-5012
Mailing Address - Country:US
Mailing Address - Phone:702-901-4227
Mailing Address - Fax:
Practice Address - Street 1:10315 PARKVIEW MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-5012
Practice Address - Country:US
Practice Address - Phone:702-901-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5652-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical