Basic Information
| Provider Information | |||||||||
| NPI: | 1518188788 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAZ RUBIO | ||||||||
| FirstName: | LUIS | ||||||||
| MiddleName: | FERMIN | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35 DOCK ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107012733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149651109 | ||||||||
| FaxNumber: | 9149659705 | ||||||||
| Practice Location | |||||||||
| Address1: | 35 DOCK ST | ||||||||
| Address2: | |||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149651109 | ||||||||
| FaxNumber: | 9149659705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 008728 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | LMHC5613 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.