Provider Demographics
NPI:1528461738
Name:DIAZ, SUSAN NICOLE (LCSW)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:NICOLE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:NICOLE
Other - Last Name:DE LA ROSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5009 PANORAMA DR # NA
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-1846
Mailing Address - Country:US
Mailing Address - Phone:661-241-0832
Mailing Address - Fax:
Practice Address - Street 1:5009 PANORAMA DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-1846
Practice Address - Country:US
Practice Address - Phone:661-241-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049211041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical