Basic Information
Provider Information
NPI: 1003002726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIAMOND
FirstName: ROBERT
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: LCSW-R
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 380 LEXINGTON AVE
Address2: SUITE 1700
City: NEW YORK
State: NY
PostalCode: 101680002
CountryCode: US
TelephoneNumber: 2127403689
FaxNumber:  
Practice Location
Address1: 380 LEXINGTON AVE
Address2: SUITE 1700
City: NEW YORK
State: NY
PostalCode: 101680002
CountryCode: US
TelephoneNumber: 2127403689
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/16/2007
LastUpdateDate: 08/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XR048777-1NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

ID Information
IDTypeStateIssuerDescription
0351211805NY MEDICAID


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