Provider Demographics
NPI:1003068925
Name:SAGON, BEVLYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEVLYN
Middle Name:
Last Name:SAGON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N. DIXIE HWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432
Mailing Address - Country:US
Mailing Address - Phone:561-447-1167
Mailing Address - Fax:561-447-1164
Practice Address - Street 1:1700 N. DIXIE HWY
Practice Address - Street 2:SUITE 150
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-447-1167
Practice Address - Fax:561-447-1164
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7653103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical