MEDICARE: DR. DONNA LABARGE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist	PY10030	FL

General Provider Information

NPI Number	:	1124523204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA LABARGE PHD

Provider Business Mailing Address
First Line	:	1208 NW 6TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-4245
Country	:	US
Telephone Number	:	352-379-2829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 NW 6TH ST
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32601-4245
Country	:	US
Telephone Number	:	352-379-2829
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	03/29/2018

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