Provider Demographics
NPI:1689738254
Name:BACIGALUPE, GONZALO (EDD)
Entity Type:Individual
Prefix:DR
First Name:GONZALO
Middle Name:
Last Name:BACIGALUPE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2212
Mailing Address - Country:US
Mailing Address - Phone:617-872-3249
Mailing Address - Fax:
Practice Address - Street 1:9 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:AUBURNDALE
Practice Address - State:MA
Practice Address - Zip Code:02466-2212
Practice Address - Country:US
Practice Address - Phone:617-872-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist