Individual
SAMANTHA DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1 BOSTON MEDICAL CTR PL, BOSTON, MA 02118-2908
(617) 414-5245
(617) 414-5520
Mailing address
960 MASSACHUSETTS AVE, FL 2, BOSTON, MA 02118-2690
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY5000463
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110203423A
—
MA
Enumeration date
06/24/2021
Last updated
12/04/2024
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