Provider Demographics
NPI:1003002726
Name:DIAMOND, ROBERT (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 MADISON AVE STE 1102
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1032
Mailing Address - Country:US
Mailing Address - Phone:212-740-3689
Mailing Address - Fax:
Practice Address - Street 1:271 MADISON AVE STE 1102
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1032
Practice Address - Country:US
Practice Address - Phone:212-740-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-16
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048777-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03512118Medicaid