Provider Demographics
NPI:1831501527
Name:DIAMOND, DEBORAH (PSYS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 SOUTH U.S HIGHWAY 1
Mailing Address - Street 2:SUITE D4
Mailing Address - City:FT. PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982
Mailing Address - Country:US
Mailing Address - Phone:772-215-0229
Mailing Address - Fax:
Practice Address - Street 1:2814 SOUTH U.S HIGHWAY 1
Practice Address - Street 2:SUITE D4
Practice Address - City:FT. PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982
Practice Address - Country:US
Practice Address - Phone:772-215-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1064103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool