Provider Demographics
NPI:1891557104
Name:GINA DELGARDO, PH.D. BEHAVIORAL MEDICINE AND FORENSIC SERVICES
Entity Type:Organization
Organization Name:GINA DELGARDO, PH.D. BEHAVIORAL MEDICINE AND FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELGARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:423-427-6822
Mailing Address - Street 1:PO BOX 4896
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-0896
Mailing Address - Country:US
Mailing Address - Phone:423-427-6822
Mailing Address - Fax:
Practice Address - Street 1:200 W MARTIN LUTHER KING BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2571
Practice Address - Country:US
Practice Address - Phone:423-427-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty