Provider Demographics
NPI:1043067077
Name:IRWIN, DIAMOND ELIZABETH (BCBA)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:ELIZABETH
Last Name:IRWIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DIAMOND
Other - Middle Name:ELIZABETH
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:521 STONELEIGH CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46231-2575
Mailing Address - Country:US
Mailing Address - Phone:317-450-1616
Mailing Address - Fax:
Practice Address - Street 1:1440 E 46TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2021
Practice Address - Country:US
Practice Address - Phone:317-918-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-24-72734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst