Provider Demographics
NPI:1891949780
Name:DIAMOND, LELE (MFT)
Entity Type:Individual
Prefix:MS
First Name:LELE
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FORREST AVE
Mailing Address - Street 2:SYMBIO INC
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930
Mailing Address - Country:US
Mailing Address - Phone:415-648-3243
Mailing Address - Fax:415-590-2330
Practice Address - Street 1:393 SEVENTH AVENUE SUITE 302
Practice Address - Street 2:SYMBIO INC
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118
Practice Address - Country:US
Practice Address - Phone:415-648-3243
Practice Address - Fax:415-590-2330
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT40324103TC2200X, 106H00000X, 103TF0000X
CA40324106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist