Provider Demographics
NPI:1629724497
Name:GAGLIANO, MARIE L (AC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2185 LEMOINE AVENUE
Mailing Address - Street 2:UNIT 1G
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024
Mailing Address - Country:US
Mailing Address - Phone:877-959-8180
Mailing Address - Fax:866-535-3188
Practice Address - Street 1:2185 LEMOINE AVENUE
Practice Address - Street 2:UNIT 1G
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:877-959-8180
Practice Address - Fax:866-535-3188
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37AC00177600OtherSTATE LICENSE