Basic Information
Provider Information
NPI: 1235444761
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DIAMENT
FirstName: VERONICA
MiddleName: MICHELLE
NamePrefix: MRS.
NameSuffix:  
Credential: BSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 745 W MOANA LN STE 100
Address2:  
City: RENO
State: NV
PostalCode: 895094940
CountryCode: US
TelephoneNumber: 7753343033
FaxNumber: 7753343022
Practice Location
Address1: 745 W MOANA LN STE 100
Address2:  
City: RENO
State: NV
PostalCode: 895094940
CountryCode: US
TelephoneNumber: 7753343033
FaxNumber: 7753343022
Other Information
ProviderEnumerationDate: 08/09/2010
LastUpdateDate: 08/09/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000X  Y Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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