Provider Demographics
NPI:1013068584
Name:DIAMOND, ERIC LAWRENCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LAWRENCE
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 NW 28TH LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7432
Mailing Address - Country:US
Mailing Address - Phone:352-375-3001
Mailing Address - Fax:352-375-1003
Practice Address - Street 1:4131 NW 28TH LN
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7432
Practice Address - Country:US
Practice Address - Phone:352-375-3001
Practice Address - Fax:352-375-1003
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPYOOO3331103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-3255945Medicare UPIN
FL75426Medicare ID - Type Unspecified