Provider Demographics
NPI:1528463270
Name:DIAZ, LUIS E SR (COUNSELOR)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:DIAZ
Suffix:SR
Gender:M
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1801
Mailing Address - Country:US
Mailing Address - Phone:508-754-1141
Mailing Address - Fax:508-754-1115
Practice Address - Street 1:1280 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-1801
Practice Address - Country:US
Practice Address - Phone:508-754-1141
Practice Address - Fax:508-754-1115
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor