Basic Information
| Provider Information | |||||||||
| NPI: | 1922278183 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ERIC DIAMOND PHD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4131 NW 28TH LN | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | 3523751003 | ||||||||
| Practice Location | |||||||||
| Address1: | 4131 NW 28TH LN | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326067432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523753001 | ||||||||
| FaxNumber: | 3523751003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | DIAMOND | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 3523753001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PY3331 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.