Provider Demographics
NPI:1346911849
Name:DIAMOND, TAMARA ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANNE
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28490 AVENUE STANFORD
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-0921
Mailing Address - Country:US
Mailing Address - Phone:213-663-8361
Mailing Address - Fax:
Practice Address - Street 1:24405 CHESTNUT ST STE 101
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2852
Practice Address - Country:US
Practice Address - Phone:661-714-0775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical