Provider Demographics
NPI:1467594085
Name:CIAGLIA, RICHARD G (MA LISAL)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:G
Last Name:CIAGLIA
Suffix:
Gender:M
Credentials:MA LISAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3618
Mailing Address - Country:US
Mailing Address - Phone:602-707-2418
Mailing Address - Fax:602-707-2040
Practice Address - Street 1:1102 W HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2470
Practice Address - Country:US
Practice Address - Phone:602-707-2418
Practice Address - Fax:602-707-2040
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLSAC10488101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ126285Medicaid