Healthcare Provider Details

I. General information

NPI: 1992295455
Provider Name (Legal Business Name): RACHEL DIAMOND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2018
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 E BALTIMORE PIKE STE 300
MEDIA PA
19063-5173
US

IV. Provider business mailing address

1055 E BALTIMORE PIKE STE 300
MEDIA PA
19063-5173
US

V. Phone/Fax

Practice location:
  • Phone: 610-892-3800
  • Fax:
Mailing address:
  • Phone: 610-892-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW135183
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW025342
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: