Provider Demographics
NPI:1326458654
Name:ZAK, DIANA (MS SP ED)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ZAK
Suffix:
Gender:F
Credentials:MS SP ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 PRESTON H
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4905
Mailing Address - Country:US
Mailing Address - Phone:917-770-8226
Mailing Address - Fax:305-402-8554
Practice Address - Street 1:299 PRESTON H
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4905
Practice Address - Country:US
Practice Address - Phone:917-770-8226
Practice Address - Fax:305-402-8554
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
FLRBT-23-277531106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251300000XAgenciesLocal Education Agency (LEA)