Provider Demographics
NPI:1477935591
Name:DIAMOND, STACEY
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 WILLIAMSBURY APT 333
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2265
Mailing Address - Country:US
Mailing Address - Phone:248-254-2580
Mailing Address - Fax:
Practice Address - Street 1:931 WILLIAMSBURY APT 333
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2265
Practice Address - Country:US
Practice Address - Phone:248-254-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator