Provider Demographics
NPI:1992912778
Name:DIAMOND, PHYLLIS HELEN (LCSW)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:HELEN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W END AVE
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5401
Mailing Address - Country:US
Mailing Address - Phone:212-724-2353
Mailing Address - Fax:212-724-1186
Practice Address - Street 1:170 W END AVE
Practice Address - Street 2:SUITE 1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5401
Practice Address - Country:US
Practice Address - Phone:212-724-2353
Practice Address - Fax:212-724-1186
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR008326-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN47201Medicare ID - Type Unspecified