Provider Demographics
NPI:1154630614
Name:DIAMOND, ERIC R (MSED, BCBA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:R
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BUXTON FARM RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1224
Mailing Address - Country:US
Mailing Address - Phone:203-674-8200
Mailing Address - Fax:203-674-8202
Practice Address - Street 1:30 BUXTON FARM RD
Practice Address - Street 2:SUITE 105
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1224
Practice Address - Country:US
Practice Address - Phone:203-674-8200
Practice Address - Fax:203-674-8202
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1052198103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst