Provider Demographics
NPI:1205044302
Name:DIAMOND, DEBORAH LYNN (MS, LMHC)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:LYNN
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GIBBS AVE
Mailing Address - Street 2:#6
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3383
Mailing Address - Country:US
Mailing Address - Phone:401-841-5139
Mailing Address - Fax:
Practice Address - Street 1:371 BROADWAY
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02909-1448
Practice Address - Country:US
Practice Address - Phone:401-578-7793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00152101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIDD53682Other'017' LICENSED THERAPIST