Carmen M Diaz PHD
Organization Active NPI Clinical Psychologist · Las Cruces, NM
NPI 1144638271 · NPPES record last updated Dec 2, 2014
Key facts
- NPI
- 1144638271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Legal business name
- CARMEN M DIAZ PHD
- Practice address
- 2507 N Telshor Blvd
Ste A4
Las Cruces, NM 88011-8285 - Phone
- (575) 522-5802
- NPI assigned
- Aug 1, 2014
- Organization subpart
- No
Authorized official
- Name
- Karla Chavez
- Title
- Business Manager
- Phone
- (575) 522-5802
Practitioners 2
-
Carmen Margarita Diaz, PH.D.
-
Samantha J. Littlefield, LISW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150123002117 | NM | Part B Supplier - Clinic/Group Practice | 9234453101 |
Receives reassigned benefits from 1 practitioner Practice locations: Las Cruces, NM |
National Provider Directory
Locations
201 N Church St
Ste 200B
Las Cruces, NM 88001
Phone (575) 522-5802
3831 E Lohman Ave
Ste 202
Las Cruces, NM 88011
Phone (575) 522-5802
201 N Church St
Ste 200
Las Cruces, NM 88001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | Yes |
Addresses
Primary practice location
2507 N Telshor Blvd
Ste A4
Las Cruces, NM 88011-8285
Mailing address
2507 N Telshor Blvd
Ste A4
Las Cruces, NM 88011-8285
Phone (575) 522-5802
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62125729 | Medicaid | NM | |
| 00679577 | Medicaid | NM |
Other providers in Las Cruces, NM
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- Caring LLC
- Carlacare, Inc.
- Carlos a Cadena DPM PC
- Kim Carlsen
- Tracie Lynn Carmichael
- Ghiovanna Carmona
- Wreatha Carner
- Dora Caro
- Geneva Caro
All providers in Las Cruces, NM · Clinical Psychologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.