Provider Demographics
NPI:1225032790
Name:PUGLIESE, FRANK ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:ANTHONY
Last Name:PUGLIESE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2027 SOUTH 61ST STREET
Mailing Address - Street 2:SUITE 126
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-6817
Mailing Address - Country:US
Mailing Address - Phone:254-774-8272
Mailing Address - Fax:254-774-8290
Practice Address - Street 1:2027 SOUTH 61ST ST.
Practice Address - Street 2:SUITE 126
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6817
Practice Address - Country:US
Practice Address - Phone:254-774-8272
Practice Address - Fax:254-774-8290
Is Sole Proprietor?:No
Enumeration Date:2005-06-11
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0981904-01Medicaid
TXER43Medicare ID - Type Unspecified