Provider Demographics
NPI:1174032916
Name:DIAMOND, ELIZABETH PAIGE (MED, MS, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:PAIGE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MED, MS, LMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:PAIGE
Other - Last Name:GILBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, MS, LMFT
Mailing Address - Street 1:2401 PENNSYLVANIA AVE
Mailing Address - Street 2:1A2
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130
Mailing Address - Country:US
Mailing Address - Phone:267-428-2607
Mailing Address - Fax:
Practice Address - Street 1:2401 PENNSYLVANIA AVE
Practice Address - Street 2:1A2
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130
Practice Address - Country:US
Practice Address - Phone:267-428-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2018-01-17
Deactivation Date:2017-12-02
Deactivation Code:
Reactivation Date:2018-01-17
Provider Licenses
StateLicense IDTaxonomies
PAMF000944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty