Provider Demographics
NPI:1467476432
Name:DRAGO, ANTHONY L (EDD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:DRAGO
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 1:127 KETTLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7131
Mailing Address - Country:US
Mailing Address - Phone:570-476-6301
Mailing Address - Fax:570-620-2131
Practice Address - Street 1:79 S COURTLAND ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-2865
Practice Address - Country:US
Practice Address - Phone:570-476-6301
Practice Address - Fax:570-620-2131
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004331L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS004331LOtherSTATE LICENSE