MEDICARE: DR. STEPHANIE E DIAMOND PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1366719908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE E DIAMOND PH.D.

Provider Business Mailing Address
First Line	:	35 NE 40TH ST
Second Line	:	SUITE 202
City	:	MIAMI
State	:	FL
Zip	:	33137-3502
Country	:	US
Telephone Number	:	305-505-7605
Fax Number	:	305-505-7605

Provider Business Practice Location Address
First Line	:	35 NE 40TH ST
Second Line	:	SUITE 202
City	:	MIAMI
State	:	FL
Zip	:	33137-3502
Country	:	US
Telephone Number	:	305-505-7605
Fax Number	:	305-505-7605

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	10/12/2016

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