Provider Demographics
NPI:1295892743
Name:SUGARMAN, BAHIRA H (MSSW)
Entity type:Individual
Prefix:MS
First Name:BAHIRA
Middle Name:H
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 NE 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4391
Mailing Address - Country:US
Mailing Address - Phone:352-333-3705
Mailing Address - Fax:352-331-5672
Practice Address - Street 1:115 NE 7TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4391
Practice Address - Country:US
Practice Address - Phone:352-333-3705
Practice Address - Fax:352-331-5672
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12701041C0700X
FLMT525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1025OtherBLUE CROSS BLUE SHIELD
Z1025Medicare ID - Type Unspecified