Individual
KELLY ANN DIAZ-HYDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
55 FODEN RD, SOUTH PORTLAND, ME 04106-1717
(207) 854-1030
Mailing address
55 FODEN RD, SOUTH PORTLAND, ME 04106-1717
(954) 415-5910
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LSX20864
ME
1041C0700X
Clinical Social Worker
Primary
MC22550
ME
Other
Enumeration date
05/11/2023
Last updated
10/15/2025
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