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General NPI Number Information
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NPI Number | 1619744323
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Entity Type | Individual
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Provider Name | LIONEL DIAMOND APRN-PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 03/07/2024
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Provider Practice Location Address
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Address Line | 7 EMERALD CT
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City | LAKEWOOD
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State | NJ
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Zip | 08701-3977
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Country | US
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Telephone | 732-355-3734
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Fax |
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Provider Business Mailing Address
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Address Line | 1025 NETHERWOOD DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5565
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ14968800
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License Number State | NJ
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