Provider Demographics
NPI:1396040911
Name:BAGDADE AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BAGDADE AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/PRINCIPAL OWN
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BAGDADE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-471-9419
Mailing Address - Street 1:2945 HAZELWOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1243
Mailing Address - Country:US
Mailing Address - Phone:651-417-9419
Mailing Address - Fax:651-326-3626
Practice Address - Street 1:2945 HAZELWOOD ST STE 200
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1243
Practice Address - Country:US
Practice Address - Phone:651-471-9419
Practice Address - Fax:651-326-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4527103TC0700X
MNLP4527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty