Provider Demographics
NPI:1831677426
Name:GALAM, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GALAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N BAYSHORE DRIVE #1A-122, MIAMI, FL 33132
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132
Mailing Address - Country:US
Mailing Address - Phone:954-400-3251
Mailing Address - Fax:
Practice Address - Street 1:1900 N BAYSHORE DR STE 1A-122
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-3001
Practice Address - Country:US
Practice Address - Phone:954-400-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-60935106S00000X
FL18-60935106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG450-780-76-707-0Medicaid