Provider Demographics
NPI:1134425002
Name:JASEPH, MARY DIAMOND (LMHC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DIAMOND
Last Name:JASEPH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 PITT ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-4806
Mailing Address - Country:US
Mailing Address - Phone:505-453-7019
Mailing Address - Fax:
Practice Address - Street 1:3424 PITT ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-4806
Practice Address - Country:US
Practice Address - Phone:505-453-7019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0122261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health