Provider Demographics
NPI:1841473741
Name:SUSAN SAGMAN PA
Entity type:Organization
Organization Name:SUSAN SAGMAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FAITH
Authorized Official - Last Name:SAGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-929-0996
Mailing Address - Street 1:21691 ABINGTON CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4831
Mailing Address - Country:US
Mailing Address - Phone:561-929-0996
Mailing Address - Fax:561-218-6029
Practice Address - Street 1:21691 ABINGTON CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4831
Practice Address - Country:US
Practice Address - Phone:561-929-0996
Practice Address - Fax:561-218-6029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW3461251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8118515Medicaid