Provider Demographics
NPI:1215294954
Name:BADER-ANDERSON, DIANE ROBIN (SW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ROBIN
Last Name:BADER-ANDERSON
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 PINE GREEN TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-6247
Mailing Address - Country:US
Mailing Address - Phone:941-915-1594
Mailing Address - Fax:
Practice Address - Street 1:4642 PINE GREEN TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-6247
Practice Address - Country:US
Practice Address - Phone:941-915-1594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC060788001041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical