Provider Demographics
NPI:1740829837
Name:SYNERGEN BEHAVIORAL HEALTH, P.A.
Entity type:Organization
Organization Name:SYNERGEN BEHAVIORAL HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:HARDRICT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:651-433-7207
Mailing Address - Street 1:2785 WHITE BEAR AVE N STE 105
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1320
Mailing Address - Country:US
Mailing Address - Phone:651-433-7207
Mailing Address - Fax:651-410-1502
Practice Address - Street 1:2785 WHITE BEAR AVE N STE 105
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1320
Practice Address - Country:US
Practice Address - Phone:651-433-7207
Practice Address - Fax:651-410-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-06
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health