Provider Demographics
NPI:1699119156
Name:GAMARRA, ALBERTO N (PH D)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:N
Last Name:GAMARRA
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N COMMERCE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3216
Mailing Address - Country:US
Mailing Address - Phone:954-804-4719
Mailing Address - Fax:954-389-0976
Practice Address - Street 1:1625 N COMMERCE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3216
Practice Address - Country:US
Practice Address - Phone:954-804-4719
Practice Address - Fax:954-389-0976
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TE1100X
FLSS 754103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports