Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PY7653 | FL |
Y | 103T00000X | Psychologist | PY7653 | FL |
N | 103G00000X | Clinical Psychologist | PY7653 | FL |
N | 103TC0700X | Clinical Psychologist | PY7653 | FL |
NPI | 1003068925 |
---|---|
Provider Name | Dr. Bevlyn Sagon |
First Address | Boca Raton, FL 33432 |
Second Address | Boca Raton, FL 33432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2008 |
Last Update Date | 12/12/2012 |