Provider Demographics
NPI:1043499973
Name:DIAMOND, MARC H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:H
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 ASHFORD AVE
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-2424
Mailing Address - Country:US
Mailing Address - Phone:914-693-4801
Mailing Address - Fax:914-693-4927
Practice Address - Street 1:616 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2424
Practice Address - Country:US
Practice Address - Phone:914-693-4801
Practice Address - Fax:914-693-4927
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-27
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR024329-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7494094-99OtherGHI
NYN71811Medicare PIN