Individual
JUVENTINO DIEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
165 MERMAID LN, BRONX, NY 10473-2499
(929) 303-0024
Mailing address
165 MERMAID LN, BRONX, NY 10473-2499
(929) 303-0024
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
175T00000X
Peer Specialist
Primary
—
NY
Other
Enumeration date
10/17/2019
Last updated
10/17/2019
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