Provider Demographics
NPI:1093908782
Name:MICHAEL GAROFANO, PH.D., LLC
Entity Type:Organization
Organization Name:MICHAEL GAROFANO, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAROFANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-713-7142
Mailing Address - Street 1:801 TOLL HOUSE AVE
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4564
Mailing Address - Country:US
Mailing Address - Phone:301-663-1411
Mailing Address - Fax:301-663-1412
Practice Address - Street 1:801 TOLL HOUSE AVE
Practice Address - Street 2:SUITE A-3
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4564
Practice Address - Country:US
Practice Address - Phone:301-663-1411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-25
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04034103G00000X, 103T00000X, 103TH0004X
NC2772103G00000X, 103T00000X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty