Provider Demographics
NPI:1871644567
Name:BAGROSKY, MARYPAT (MA)
Entity Type:Individual
Prefix:MS
First Name:MARYPAT
Middle Name:
Last Name:BAGROSKY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-2190
Mailing Address - Country:US
Mailing Address - Phone:989-631-5579
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:42ND CIRCUIT CT. JUVENILE COURT
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5162
Practice Address - Country:US
Practice Address - Phone:989-832-6855
Practice Address - Fax:989-832-6607
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional