Individual
JACELYN DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
319 BEECH ST, HOLYOKE, MA 01040-3968
(413) 540-1115
Mailing address
319 BEECH ST, HOLYOKE, MA 01040-3968
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YS0200X
School Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042174657
—
MA
Enumeration date
05/16/2020
Last updated
05/16/2020
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