=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407146277
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONI DIAMOND LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2011
-----------------------------------------------------
Last Update Date | 07/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16014 CELTIC ST
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-470-7346
-----------------------------------------------------
Fax | 818-832-9941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14407 HAMLIN ST STE E
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91401-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-988-2018
-----------------------------------------------------
Fax | 818-832-9941
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS11876
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------