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General NPI Number Information
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NPI Number | 1528341963
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Entity Type | Individual
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Provider Name | CHANA MALKA DIAMOND LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 175 FULTON AVE 3RD FLOOR
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City | HEMPSTEAD
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State | NY
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Zip | 11550-3718
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Country | US
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Telephone | 516-485-5710
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Fax |
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Provider Business Mailing Address
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Address Line | 11040 72ND AVE APARTMENT 1A
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City | FOREST HILLS
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State | NY
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Zip | 11375-4949
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Country | US
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Telephone | 516-316-0162
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 080900
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License Number State | NY
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