Provider Demographics
NPI:1023020567
Name:LAGOS, JOHN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:LAGOS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2440
Mailing Address - Country:US
Mailing Address - Phone:973-635-4933
Mailing Address - Fax:973-635-4851
Practice Address - Street 1:283 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2440
Practice Address - Country:US
Practice Address - Phone:973-635-4933
Practice Address - Fax:973-635-4851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1046103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist