Provider Demographics
NPI:1205940038
Name:GAGLIANO, JOSEPH M (LCSWR)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:GAGLIANO
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FROST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-1400
Mailing Address - Country:US
Mailing Address - Phone:631-828-5035
Mailing Address - Fax:631-509-1839
Practice Address - Street 1:660 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2203
Practice Address - Country:US
Practice Address - Phone:631-828-2592
Practice Address - Fax:631-828-2592
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0496211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN26691Medicare PIN