Basic Information
| Provider Information | |||||||||
| NPI: | 1912107376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAMOND | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 S OAK KNOLL AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911012611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6269933000 | ||||||||
| FaxNumber: | 6267957080 | ||||||||
| Practice Location | |||||||||
| Address1: | 11643 GLENOAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | PACOIMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913311050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188972609 | ||||||||
| FaxNumber: | 8188907159 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 100515 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.