Provider Demographics
NPI:1831747054
Name:MICHAEL GUGERTY, PSY.D. LLC
Entity type:Organization
Organization Name:MICHAEL GUGERTY, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:443-991-5938
Mailing Address - Street 1:6525 N. CHARLES ST.
Mailing Address - Street 2:GIBSON BUILDING SUITE 135
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:443-991-5938
Mailing Address - Fax:667-206-2186
Practice Address - Street 1:6525 N. CHARLES ST.
Practice Address - Street 2:GIBSON BUILDING SUITE 135
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:443-991-5938
Practice Address - Fax:667-206-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty