=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114374188
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN ANTONIO GALARZA PSY.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2016
-----------------------------------------------------
Last Update Date | 12/23/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1695 MAIN ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01103-1348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 413-739-5572
-----------------------------------------------------
Fax | 413-739-9972
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 E SILVER SPRINGS BLVD STE 217
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34470-6844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-732-3333
-----------------------------------------------------
Fax | 352-732-2469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------