Provider Demographics
NPI:1861191561
Name:DIAZ, AMOS M
Entity type:Individual
Prefix:
First Name:AMOS
Middle Name:M
Last Name:DIAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 ACORN HILL RD
Mailing Address - Street 2:
Mailing Address - City:OLIVEBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12461-5440
Mailing Address - Country:US
Mailing Address - Phone:845-663-4008
Mailing Address - Fax:
Practice Address - Street 1:26 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1378
Practice Address - Country:US
Practice Address - Phone:845-397-7101
Practice Address - Fax:845-428-7815
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty