Healthcare Provider Details

I. General information

NPI: 1205052966
Provider Name (Legal Business Name): RACHEL DIAMOND PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PIERREPONT ST SUITE B
BROOKLYN NY
11201-2452
US

IV. Provider business mailing address

716 AVENUE K
BROOKLYN NY
11230-4104
US

V. Phone/Fax

Practice location:
  • Phone: 718-624-0431
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0144171
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0144171
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: