Provider Demographics
NPI:1831429695
Name:DIANE ABDO PSY D PA
Entity type:Organization
Organization Name:DIANE ABDO PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ABDO
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:561-393-5363
Mailing Address - Street 1:7673 SIERRA TER W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3315
Mailing Address - Country:US
Mailing Address - Phone:561-393-5363
Mailing Address - Fax:561-361-6706
Practice Address - Street 1:398 CAMINO GARDENS BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5827
Practice Address - Country:US
Practice Address - Phone:561-393-5363
Practice Address - Fax:561-361-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY003959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty