Provider Demographics
NPI:1144578014
Name:DIAMOND, ERIC LEWIS (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LEWIS
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7821 N FAIRCHILD RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3116
Mailing Address - Country:US
Mailing Address - Phone:406-396-3028
Mailing Address - Fax:
Practice Address - Street 1:7821 N FAIRCHILD RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3116
Practice Address - Country:US
Practice Address - Phone:406-396-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7817-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical