Provider Demographics
NPI:1801352471
Name:GALLAGHER, JENNIFER SINCORE (PSYD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SINCORE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SINCORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4233 W HILLSBORO BLVD # 284
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33097-1201
Mailing Address - Country:US
Mailing Address - Phone:305-582-7689
Mailing Address - Fax:
Practice Address - Street 1:10675 NW 40TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:305-582-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10337103T00000X
FLPY103771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY10377OtherLICENSED PSYCHOLOGIST