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General NPI Number Information
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NPI Number | 1184710550
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Entity Type | Individual
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Provider Name | LISA C. DIAMOND M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 03/10/2025
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Provider Practice Location Address
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Address Line | 2131 KIRKWOOD BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-1540
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Country | US
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Telephone | 817-210-4856
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Fax |
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Provider Business Mailing Address
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Address Line | 11 HIGH POINT LN
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City | WEST HARTFORD
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State | CT
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Zip | 06107-1136
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Country | US
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Telephone | 203-770-1357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 029445
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License Number State | CT
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