Provider Demographics
NPI:1588196356
Name:MARTINE M. DUGARD
Entity Type:Organization
Organization Name:MARTINE M. DUGARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:954-592-7578
Mailing Address - Street 1:201 NE 23RD CT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-4952
Mailing Address - Country:US
Mailing Address - Phone:954-592-7578
Mailing Address - Fax:
Practice Address - Street 1:201 NE 23RD CT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4952
Practice Address - Country:US
Practice Address - Phone:954-592-7578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness