Provider Demographics
NPI:1033947973
Name:DIAZ, NICHOLE B (CSW)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:B
Last Name:DIAZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PENNSYLVANIA ST NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7404
Mailing Address - Country:US
Mailing Address - Phone:505-265-0753
Mailing Address - Fax:505-268-5722
Practice Address - Street 1:1110 PENNSYLVANIA ST NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7404
Practice Address - Country:US
Practice Address - Phone:505-265-0753
Practice Address - Fax:505-268-5722
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator