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General NPI Number Information
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NPI Number | 1831429695
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Entity Type | Organization
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Legal Business Name | DIANE ABDO PSY D PA
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Dates
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Enumeration Date | 12/30/2009
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Last Update Date | 12/30/2009
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Provider Practice Location Address
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Address Line | 398 CAMINO GARDENS BLVD SUITE 106
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City | BOCA RATON
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State | FL
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Zip | 33432-5827
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Country | US
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Telephone | 561-393-5363
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Fax | 561-361-6706
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Provider Business Mailing Address
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Address Line | 7673 SIERRA TER W
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City | BOCA RATON
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State | FL
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Zip | 33433-3315
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Country | US
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Telephone | 561-393-5363
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Fax | 561-361-6706
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE R ABDO
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Credential | PSY D
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Telephone | 561-393-5363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY003959
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License Number State | FL
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