Provider Demographics
NPI:1336286194
Name:DAIGNAULT, BAMBI RAE (MA)
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:RAE
Last Name:DAIGNAULT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 N MOON AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4419
Mailing Address - Country:US
Mailing Address - Phone:813-689-8828
Mailing Address - Fax:813-689-8802
Practice Address - Street 1:113 E MAIN ST
Practice Address - Street 2:SUITE # 7
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830-4630
Practice Address - Country:US
Practice Address - Phone:813-689-8828
Practice Address - Fax:813-689-8802
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health