Provider Demographics
NPI:1700934809
Name:DIAMOND, REGINE I (JD, MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:REGINE
Middle Name:I
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:JD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6181 SW 56TH CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-7212
Mailing Address - Country:US
Mailing Address - Phone:954-964-3259
Mailing Address - Fax:
Practice Address - Street 1:3999 SHERIDAN ST
Practice Address - Street 2:SUITE #201
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3635
Practice Address - Country:US
Practice Address - Phone:954-964-3259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2012-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 55031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical