Provider Demographics
NPI:1982598082
Name:DIAZ, MICHAEL A (CASAC II)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:DIAZ
Suffix:
Gender:M
Credentials:CASAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BARTELS PL APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-6946
Mailing Address - Country:US
Mailing Address - Phone:914-278-0999
Mailing Address - Fax:
Practice Address - Street 1:2015 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1015
Practice Address - Country:US
Practice Address - Phone:212-690-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-04
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)