Provider Demographics
NPI:1174988604
Name:O'GARRO, KATHLEEN (EDS, MSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:O'GARRO
Suffix:
Gender:F
Credentials:EDS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 NW 2ND AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6692
Mailing Address - Country:US
Mailing Address - Phone:340-220-5114
Mailing Address - Fax:
Practice Address - Street 1:2840 NW 2ND AVE STE 104
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6692
Practice Address - Country:US
Practice Address - Phone:340-220-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI0101-BEX-11103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool