1992988653 NPI number — GAIL BAGLEY LPC

Table of content: GAIL BAGLEY LPC (NPI 1992988653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992988653 NPI number — GAIL BAGLEY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAGLEY
Provider First Name:
GAIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992988653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 CHAMBORD PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06002-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-243-0156
Provider Business Mailing Address Fax Number:
860-243-0156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 CHAMBORD PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06002-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-243-0156
Provider Business Practice Location Address Fax Number:
860-243-0156
Provider Enumeration Date:
12/17/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  001530 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)