Provider Demographics
NPI:1972275204
Name:GAGLIANO, STACEY (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:GAGLIANO
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:MISS
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:PERLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCSP
Mailing Address - Street 1:1243 EASTON RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-3801
Mailing Address - Country:US
Mailing Address - Phone:215-491-1119
Mailing Address - Fax:
Practice Address - Street 1:1243 EASTON RD STE 203
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-3801
Practice Address - Country:US
Practice Address - Phone:215-491-1119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019412103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist