Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | R048777-1 | NY |
NPI | 1003002726 |
---|---|
Provider Name | Mr. Robert Diamond |
First Address | New York, NY 10016-1032 |
Second Address | New York, NY 10016-1032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2007 |
Last Update Date | 04/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03512118 | (05) | NY |