Provider Demographics
NPI:1235204454
Name:MAGILL, JOAN TORGERSEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:TORGERSEN
Last Name:MAGILL
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 1:2200 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7307
Mailing Address - Country:US
Mailing Address - Phone:561-981-8802
Mailing Address - Fax:561-737-0986
Practice Address - Street 1:2200 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7307
Practice Address - Country:US
Practice Address - Phone:561-981-8802
Practice Address - Fax:561-737-0986
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5563103T00000X
FLMT1482106H00000X
MAMH51106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54636Medicare ID - Type Unspecified