Provider Demographics
NPI:1457753501
Name:DIANNE C. WOOD BCBA
Entity Type:Organization
Organization Name:DIANNE C. WOOD BCBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-267-8076
Mailing Address - Street 1:5915 SEA RANCH DR
Mailing Address - Street 2:UNIT 907
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-4557
Mailing Address - Country:US
Mailing Address - Phone:727-267-8076
Mailing Address - Fax:866-420-1763
Practice Address - Street 1:5915 SEA RANCH DR
Practice Address - Street 2:UNIT 907
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-4557
Practice Address - Country:US
Practice Address - Phone:727-267-8076
Practice Address - Fax:866-420-1763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002558100Medicaid