Provider Demographics
NPI:1487132254
Name:PI SAGION, YENNY
Entity type:Individual
Prefix:
First Name:YENNY
Middle Name:
Last Name:PI SAGION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 MIRROR LAKES CT
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-9541
Mailing Address - Country:US
Mailing Address - Phone:561-543-7896
Mailing Address - Fax:
Practice Address - Street 1:692 MIRROR LAKES CT
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33974-9541
Practice Address - Country:US
Practice Address - Phone:561-543-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-69662103K00000X, 103K00000X
FLRBT-18-60157106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022710900Medicaid