Provider Demographics
NPI:1801973631
Name:MCGUIGAN, BETTY JANE (PHD)
Entity type:Individual
Prefix:DR
First Name:BETTY
Middle Name:JANE
Last Name:MCGUIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11325 S. OLD DIXIE HWY.
Mailing Address - Street 2:#15
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-388-1188
Mailing Address - Fax:772-388-1188
Practice Address - Street 1:11325 S. OLD DIXIE HWY.
Practice Address - Street 2:#15
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-388-1188
Practice Address - Fax:772-388-1188
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5993103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist