Basic Information
| Provider Information | |||||||||
| NPI: | 1326430521 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABOGAL | ||||||||
| FirstName: | SUSAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5152 VENTURA DR | ||||||||
| Address2: | DELRAY BEACH | ||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334848382 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615086122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9000 BURMA RD | ||||||||
| Address2: | #103 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615086122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2015 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.