Provider Demographics
NPI:1003673773
Name:HARVEY, DIOMARA KASHUALY
Entity type:Individual
Prefix:MS
First Name:DIOMARA
Middle Name:KASHUALY
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DIOMARA
Other - Middle Name:KASHUALY
Other - Last Name:CAMACHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7547 COPPER CREST VW APT G203
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-4817
Mailing Address - Country:US
Mailing Address - Phone:719-828-6000
Mailing Address - Fax:
Practice Address - Street 1:7547 COPPER CREST VW APT G203
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80908-4817
Practice Address - Country:US
Practice Address - Phone:171-982-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician