Healthcare Provider Details

I. General information

NPI: 1174988604
Provider Name (Legal Business Name): KATHLEEN O'GARRO EDS, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 12/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 NW 2ND AVE STE 104
BOCA RATON FL
33431-6692
US

IV. Provider business mailing address

2840 NW 2ND AVE STE 104
BOCA RATON FL
33431-6692
US

V. Phone/Fax

Practice location:
  • Phone: 340-220-5114
  • Fax:
Mailing address:
  • Phone: 340-220-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0101-BEX-11
License Number StateVI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: