Provider Demographics
NPI:1619032307
Name:BAGAI, ROBIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:BAGAI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 NW HOYT ST STE 208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2700
Mailing Address - Country:US
Mailing Address - Phone:503-231-2966
Mailing Address - Fax:503-274-2420
Practice Address - Street 1:1306 NW HOYT ST STE 208
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2700
Practice Address - Country:US
Practice Address - Phone:503-231-2966
Practice Address - Fax:503-274-2420
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1008103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR042486Medicaid