Provider Demographics
NPI:1093881310
Name:GARGAN, MICHELE (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:GARGAN
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 1:62 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-2325
Mailing Address - Country:US
Mailing Address - Phone:203-438-0547
Mailing Address - Fax:
Practice Address - Street 1:51 LOCUST AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-4739
Practice Address - Country:US
Practice Address - Phone:203-966-6467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001999103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001999CT02Medicare UPIN
187960Medicare UPIN
268025000363307Medicare UPIN
107796Medicare UPIN