=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790798627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIAMOND COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 02/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 331 NEWMAN SPRINGS ROAD BUILDING 1, 4TH FLOOR, SUITE 143
-----------------------------------------------------
City | RED BANK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07701-5688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-462-7877
-----------------------------------------------------
Fax | 732-462-7879
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 MAIN ST STE 311
-----------------------------------------------------
City | MATAWAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07747-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-462-7877
-----------------------------------------------------
Fax | 732-462-7879
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DANIEL CHABAREK
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 732-462-7877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 44SC05254900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------