Provider Demographics
NPI:1871715532
Name:DIAZ, ELISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELISA
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 NW 9TH AVE
Mailing Address - Street 2:SUITE 1208
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1409
Mailing Address - Country:US
Mailing Address - Phone:305-355-7245
Mailing Address - Fax:305-355-8095
Practice Address - Street 1:1695 NW 9TH AVE
Practice Address - Street 2:SUITE 1208
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1409
Practice Address - Country:US
Practice Address - Phone:305-355-7245
Practice Address - Fax:305-355-8095
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 101YM0800X
FLPY 9372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health