Provider Demographics
NPI:1447860283
Name:SANBORN, ABIGALE JEAN BRADY (PHD)
Entity type:Individual
Prefix:
First Name:ABIGALE
Middle Name:JEAN BRADY
Last Name:SANBORN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ABBIE
Other - Middle Name:JEAN
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:6000 US 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32512-0001
Mailing Address - Country:US
Mailing Address - Phone:440-813-0014
Mailing Address - Fax:
Practice Address - Street 1:6000 US98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32512-1337
Practice Address - Country:US
Practice Address - Phone:850-505-6749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008074103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist