Individual
MS. MAYRA DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2310 W ROOSEVELT RD, CHICAGO, IL 60608-1131
(312) 655-7191
Mailing address
4945 S KEATING AVE, CHICAGO, IL 60632-4814
(708) 745-1077
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
150109660
IL
1041C0700X
Clinical Social Worker
—
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/26/2020
Last updated
05/03/2024
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