Provider Demographics
NPI:1700907458
Name:DIAMOND, MITCHELL JAY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:JAY
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1021
Mailing Address - Country:US
Mailing Address - Phone:718-633-6357
Mailing Address - Fax:718-633-6357
Practice Address - Street 1:63 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1021
Practice Address - Country:US
Practice Address - Phone:718-633-6357
Practice Address - Fax:718-633-6357
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146381OtherL.C.S.W.
NYN13702Medicare ID - Type UnspecifiedL.C.S.W.