Healthcare Provider Details

I. General information

NPI: 1912107376
Provider Name (Legal Business Name): SUSAN P. DIAMOND LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11643 GLENOAKS BLVD
PACOIMA CA
91331-1050
US

IV. Provider business mailing address

118 S OAK KNOLL AVE
PASADENA CA
91101-2611
US

V. Phone/Fax

Practice location:
  • Phone: 818-897-2609
  • Fax: 818-890-7159
Mailing address:
  • Phone: 626-993-3000
  • Fax: 626-795-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: