Suzanne Tellez Diaz, LCSW
Individual provider Active NPI Clinical Social Worker · Page, AZ
NPI 1609626449 · NPPES record last updated Mar 25, 2024
Key facts
- NPI
- 1609626449
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 22052 (AZ)
- Practice address
- 463 S Lake Powell Blvd
Page, AZ 86040-0856 - Phone
- (928) 645-5113
- NPI assigned
- Mar 25, 2024
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Presbyterian Healthcare Services
Practice addresses (Care Compare)
1325 Wyoming Blvd NE
Albuquerque, NM 87112-5046
Phone (505) 291-5300
Hospital & facility affiliations
- Presbyterian Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241106000312 | NM | Practitioner - Clinical Social Worker | 3375088479 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22052 | AZ | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Presbyterian Healthcare Services | Current |
Accepting new patients | |
| Presbyterian Healthcare Services | Current |
Accepting new patients |
Locations
1325 Wyoming Blvd NE
Albuquerque, NM 87112
Phone (505) 291-5300
2200 W 21st St
Clovis, NM 88101
Phone (505) 769-7577
Interoperability endpoints
- suzanne.diazlcswbhp.p1@direct.cbridges.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 22052 | AZ | Yes |
Addresses
Primary practice location
463 S Lake Powell Blvd
Page, AZ 86040-0856
Mailing address
PO Box 790
Page, AZ 86040-0790
Phone (928) 433-3732
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22052 | Other | AZ | LCSW LICENSE |
Other providers in Page, AZ
- Community Bridges, Inc.
- Sarah Marie Corey
- Michael J Demangone
- Desert Heights Family Clinic Professional Corporation
- Erin Nicole Dial-Duran
- Drgoodeye LLC
- E Pell Wadleigh DDS PC
- Emergency Professional Services, PC
- Encompass Health Services
- Encompass Health Services Incorporated
All providers in Page, AZ · Clinical Social Worker in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2024. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.