Provider Demographics
NPI:1184360323
Name:DIAMOND, DANIELLE MOSKOW (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:MOSKOW
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:DANIELLE
Other - Middle Name:M
Other - Last Name:MOSKOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:248 MARLBOROUGH ST APT 6
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1738
Mailing Address - Country:US
Mailing Address - Phone:610-585-8939
Mailing Address - Fax:
Practice Address - Street 1:248 MARLBOROUGH ST APT 6
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1738
Practice Address - Country:US
Practice Address - Phone:610-585-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10001030103TC0700X
390200000X
NY026603103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program