Provider Demographics
NPI:1639487416
Name:DIAMOND, MAYA (MFTI)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 LAKESIDE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1950
Mailing Address - Country:US
Mailing Address - Phone:510-262-6551
Mailing Address - Fax:
Practice Address - Street 1:4175 LAKESIDE DR STE 110
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1950
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health