Provider Demographics
NPI:1295743698
Name:PURE, DIANA NOEMI (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:NOEMI
Last Name:PURE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1545 W NORTH AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-2530
Mailing Address - Country:US
Mailing Address - Phone:847-269-0849
Mailing Address - Fax:312-782-7172
Practice Address - Street 1:900 BISCAYNE BLVD
Practice Address - Street 2:UNIT 3302
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1561
Practice Address - Country:US
Practice Address - Phone:847-269-0849
Practice Address - Fax:305-433-7039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical