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Individual

DR. JEFFREY C. DIEBOLD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
143 E PARK AVE, SECOND FLOOR, LONG BEACH, NY 11561-3548
(718) 309-7782
Mailing address
6625 103RD ST, APT 5P, FOREST HILLS, NY 11375-2046
(718) 309-7782

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
016440
NY

Other

Enumeration date
03/20/2007
Last updated
04/21/2009
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