Provider Demographics
NPI:1184633588
Name:BACIGALUPO, EDWARD M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:BACIGALUPO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 GLENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3737
Mailing Address - Country:US
Mailing Address - Phone:917-886-5284
Mailing Address - Fax:
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:SUITE G514
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1140
Practice Address - Country:US
Practice Address - Phone:917-886-5284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0072571041C0700X
NY0769761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical