Provider Demographics
NPI:1538352497
Name:DIAZ, COURTNEY BOBER (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:BOBER
Last Name:DIAZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:ALYSON
Other - Last Name:BOBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, ASW, LCSW
Mailing Address - Street 1:1340 TULLY RD STE 304
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-3055
Mailing Address - Country:US
Mailing Address - Phone:408-271-3900
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY RD STE 304
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA274381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical