Healthcare Provider Details

I. General information

NPI: 1720223092
Provider Name (Legal Business Name): ILENE DIAMOND PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2008
Last Update Date: 01/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 MARKET ST SUITE 910
SAN FRANCISCO CA
94104-5301
US

IV. Provider business mailing address

582 MARKET ST SUITE 910
SAN FRANCISCO CA
94104-5301
US

V. Phone/Fax

Practice location:
  • Phone: 415-382-0150
  • Fax:
Mailing address:
  • Phone: 415-820-1508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number21575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number21575
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number21575
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21575
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number21575
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number21575
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number21575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: