MEDICARE: DEBORAH DIAMOND PSYS

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	103TS0200X	School Psychologist	SS1064	FL

General Provider Information

NPI Number	:	1831501527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH DIAMOND PSYS

Provider Business Mailing Address
First Line	:	2814 SOUTH U.S HIGHWAY 1
Second Line	:	SUITE D4
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-215-0229
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 SOUTH U.S HIGHWAY 1
Second Line	:	SUITE D4
City	:	FT. PIERCE
State	:	FL
Zip	:	34982
Country	:	US
Telephone Number	:	772-215-0229
Fax Number	:

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

Provider Enumeration Date	:	05/29/2014
Last Update Date	:	05/29/2014

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