Provider Demographics
NPI:1679269880
Name:SGR PSYCHOLOGICAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SGR PSYCHOLOGICAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-372-5500
Mailing Address - Street 1:4800 N FEDERAL HWY STE 102E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5179
Mailing Address - Country:US
Mailing Address - Phone:561-372-5500
Mailing Address - Fax:
Practice Address - Street 1:4800 N FEDERAL HWY STE 102E
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5179
Practice Address - Country:US
Practice Address - Phone:561-372-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty