Healthcare Provider Details

I. General information

NPI: 1982973103
Provider Name (Legal Business Name): FELICIA DIAMOND - FRIED LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 PARK PL
BROOKLYN NY
11217-3303
US

IV. Provider business mailing address

148 PARK PL
BROOKLYN NY
11217-3303
US

V. Phone/Fax

Practice location:
  • Phone: 718-398-1962
  • Fax: 718-398-8942
Mailing address:
  • Phone: 718-398-1962
  • Fax: 718-398-8942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0852621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: