Individual provider · NPI-1

Jennifer Diaz

Marriage & Family Therapist · Altamonte Springs, FL

NPI number1548876196

StatusActive

Last updated in NPPESSep 18, 2020

Details

NPI: 1548876196
Entity type: Individual (NPI-1)
Name: Jennifer Diaz
Sex: Female
Sole proprietor: Yes
Enumeration date: Sep 18, 2020
Certification date: Sep 18, 2020
Last updated: Sep 18, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
106H00000X	Marriage & Family Therapist	IMT3002	FL	Yes
101YM0800X	Counselor, Mental Health	–	–
106H00000X	Marriage & Family Therapist	–	–

Practice location

632 Maitland Ave
Altamonte Springs, FL 32701-6834

Phone 407-875-5704

Mailing address

632 Maitland Ave
Altamonte Springs, FL 32701-6834

Phone 407-875-5704

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