Provider Demographics
NPI:1598722191
Name:HAHN, DIANE C (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:C
Last Name:HAHN
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 1:905 E MARTIN LUTHER KING JR DR
Mailing Address - Street 2:SUITE 214
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-4864
Mailing Address - Country:US
Mailing Address - Phone:727-937-2552
Mailing Address - Fax:
Practice Address - Street 1:905 E MARTIN LUTHER KING JR DR
Practice Address - Street 2:STE 214
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-4827
Practice Address - Country:US
Practice Address - Phone:727-937-2552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5615103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54178Medicare ID - Type UnspecifiedBCBS + MEDICARE PROVIDER