Provider Demographics
NPI:1346310406
Name:MAGLIO, DOMENICK JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICK
Middle Name:JOHN
Last Name:MAGLIO
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 1:4060 CASTLE AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2358
Mailing Address - Country:US
Mailing Address - Phone:352-686-1934
Mailing Address - Fax:
Practice Address - Street 1:4060 CASTLE AVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-2358
Practice Address - Country:US
Practice Address - Phone:352-686-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL197480OtherMAGELLAN
FL83498OtherMENTAL HEALTH NETWORK
FLZ7593OtherBLUE CROSS BLUE SHIELD