Provider Demographics
NPI:1205391547
Name:SABOL, DIANNA
Entity Type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:
Last Name:SABOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2367 MABEN CIR APT P6
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5162
Mailing Address - Country:US
Mailing Address - Phone:863-430-1337
Mailing Address - Fax:
Practice Address - Street 1:2367 MABEN CIR APT P6
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-5162
Practice Address - Country:US
Practice Address - Phone:863-430-1337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-75660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst