Provider Demographics
NPI:1407876816
Name:SANO, DEBORAH LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOUISE
Last Name:SANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-0114
Mailing Address - Country:US
Mailing Address - Phone:330-506-9610
Mailing Address - Fax:
Practice Address - Street 1:7010 SOUTH AVE STE 5
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3603
Practice Address - Country:US
Practice Address - Phone:330-953-0373
Practice Address - Fax:330-953-1373
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011855103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6627OtherOHIO LICENSE
MIOP35620Medicare UPIN
MIP3562000Medicare PIN