Individual
JENELIS DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSW
Contact information
Practice address
91 NORTHWEST DR, WHEELER CLINIC, PLAINVILLE, CT 06062
(860) 793-3500
Mailing address
91 NORTHWEST DR, WHEELER CLINIC, PLAINVILLE, CT 06062
(860) 793-3500
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060867065
—
CT
Enumeration date
04/13/2012
Last updated
04/13/2012
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