Provider Demographics
NPI:1962289116
Name:DIAZ REYES, LAURA (MA, TSSLD, BE)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:DIAZ REYES
Suffix:
Gender:F
Credentials:MA, TSSLD, BE
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, TSSLD, BE
Mailing Address - Street 1:100 HILL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7511
Mailing Address - Country:US
Mailing Address - Phone:917-837-0239
Mailing Address - Fax:
Practice Address - Street 1:3010 BRIGGS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1606
Practice Address - Country:US
Practice Address - Phone:718-584-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist