Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 6792 | NV |
Y | 1041C0700X | Clinical Social Worker | 44SC06063400 | NJ |
NPI | 1003210626 |
---|---|
Provider Name | Vanessa Diaz |
First Address | Dover, NJ 07801-3841 |
Second Address | Dover, NJ 07801-3841 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2014 |
Last Update Date | 08/02/2022 |