Provider Demographics
NPI:1245731249
Name:BARGIONE, JOSEPH L (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:BARGIONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4504 DAKIN CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-6226
Mailing Address - Country:US
Mailing Address - Phone:502-773-5258
Mailing Address - Fax:
Practice Address - Street 1:4504 DAKIN CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6226
Practice Address - Country:US
Practice Address - Phone:502-773-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-24
Last Update Date:2018-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129047103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty