MEDICARE: JON DIMOND PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1556	LA
2	103TC0700X	Clinical Psychologist	022075-1	NY
3	103TC0700X	Clinical Psychologist	PSY1001395	DC

General Provider Information

NPI Number	:	1639605033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON DIMOND PH.D.

Provider Business Mailing Address
First Line	:	2738 GENERAL PERSHING ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2738 GENERAL PERSHING ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-6226
Country	:	US
Telephone Number	:	646-418-5478
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	12/14/2020

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Directions to “ JON DIMOND PH.D.” Practice Location

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