Active NPI
Mayra Diaz
- Social Worker
- Chicago, IL
National Provider Identifier
1891308151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150109660
- Practice address
- 2310 W Roosevelt Rd
Chicago, IL 60608-1131 - Phone
- (312) 655-7191
- NPI assigned
- Aug 26, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | IL | ||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Social Worker | 104100000X | 150109660 | IL | Primary |
Addresses
Primary practice location
2310 W Roosevelt Rd
Chicago, IL 60608-1131
Mailing address
4945 S Keating Ave
Chicago, IL 60632-4814
Phone (708) 745-1077
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150109660 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714694400000",
"number": "1891308151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4945 S KEATING AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606324814",
"telephone_number": "708-745-1077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2310 W ROOSEVELT RD",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606081131",
"telephone_number": "312-655-7191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "MAYRA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-26",
"last_updated": "2024-05-03",
"certification_date": "2024-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IL",
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150109660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.