Individual
INGRID DIAZ-BALART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 KIMBALL ST STE 106, WOODBRIDGE, NJ 07095-2506
(732) 218-8600
Mailing address
307 BERGEN BLVD, FAIRVIEW, NJ 07022-1334
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
44SL06333200
NJ
Other
Enumeration date
10/22/2019
Last updated
10/22/2019
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