Individual
BERTHA DIAZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
317 NORTH ST, WHITE PLAINS, NY 10605-2209
(914) 597-4109
Mailing address
39 YOSEMITE AVE, WHITE PLAINS, NY 10607-1345
(914) 882-1928
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
958
PHYSICAL AND EMOTIONAL
—
Enumeration date
06/21/2021
Last updated
06/21/2021
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