Doctor Name: | JACQLYN ELIZABETH DIAMOND |
NPI Number: | 1477732378 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, LPC |
License Number: | PC004734 |
Business Practice Address: | 110 Park Ave Ste 2 Swarthmore, PA - 190811736 |
Business Phone Number: | 6103080010 |
Business Fax Number: | |
Mailing Address: | 1020 Harvard Ave, SWARTHMORE |
State: | PA |
Postal Code: | 190812212 |
Phone Number: | 6103080010 |
Fax Number: | |
NPI Enumeration Date: | 10/26/2007 |
NPI Last Update Date: | 05/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PC004734 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |