Provider Demographics
NPI:1528341963
Name:DIAMOND, CHANA MALKA (LCSW)
Entity type:Individual
Prefix:
First Name:CHANA
Middle Name:MALKA
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHANA
Other - Middle Name:MALKA
Other - Last Name:TOPEK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11040 72ND AVE
Mailing Address - Street 2:APARTMENT 1A
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4949
Mailing Address - Country:US
Mailing Address - Phone:516-316-0162
Mailing Address - Fax:
Practice Address - Street 1:175 FULTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3718
Practice Address - Country:US
Practice Address - Phone:516-485-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker