Provider Demographics
NPI:1194128959
Name:SUGAR, LORI
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:SUGAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7543
Mailing Address - Country:US
Mailing Address - Phone:549-774-0469
Mailing Address - Fax:549-941-1164
Practice Address - Street 1:200 SE 19TH AVE
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7543
Practice Address - Country:US
Practice Address - Phone:549-774-0469
Practice Address - Fax:549-941-1164
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
FL1-15-19220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist