Provider Demographics
NPI:1215402318
Name:SABOL, LAUREN SUZANNE (PSYD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:SUZANNE
Last Name:SABOL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ANTIGUA DR
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3201
Mailing Address - Country:US
Mailing Address - Phone:240-593-1049
Mailing Address - Fax:
Practice Address - Street 1:103 ANTIGUA DR
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3201
Practice Address - Country:US
Practice Address - Phone:240-593-1049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810006075103TC0700X
FLTPPY1442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical