Provider Demographics
NPI:1528024635
Name:MIRAGLIA, PHILLIP JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JOSEPH
Last Name:MIRAGLIA
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 1:46 LONGVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-1041
Mailing Address - Country:US
Mailing Address - Phone:610-695-8766
Mailing Address - Fax:
Practice Address - Street 1:105 SIBLEY AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2311
Practice Address - Country:US
Practice Address - Phone:610-649-8733
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002600-L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA129309Medicare ID - Type Unspecified