Provider Demographics
NPI:1962676320
Name:DIAMOND, MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICKIE
Other - Middle Name:
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1112 S BRADDOCK AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1262
Mailing Address - Country:US
Mailing Address - Phone:412-244-0450
Mailing Address - Fax:
Practice Address - Street 1:1112 S BRADDOCK AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1262
Practice Address - Country:US
Practice Address - Phone:412-244-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015759101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health