Provider Demographics
NPI:1548762149
Name:DIAZ, TONI ANNETTE
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:ANNETTE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WALLINGFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331-1507
Mailing Address - Country:US
Mailing Address - Phone:978-490-4655
Mailing Address - Fax:
Practice Address - Street 1:296 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1932
Practice Address - Country:US
Practice Address - Phone:413-774-5411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician