Provider Demographics
NPI:1265715668
Name:NGUYEN, DIEM M (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIEM
Middle Name:M
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:DIEM
Other - Middle Name:M
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1501 LOCUST ST UNIT 502
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3722
Mailing Address - Country:US
Mailing Address - Phone:323-510-7252
Mailing Address - Fax:
Practice Address - Street 1:1501 LOCUST ST UNIT 502
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3722
Practice Address - Country:US
Practice Address - Phone:323-510-7252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31927103TC0700X, 103TC0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty