Provider Demographics
NPI:1700449717
Name:BACCAGLINI, NADINE SUE (MS IN SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:SUE
Last Name:BACCAGLINI
Suffix:
Gender:F
Credentials:MS IN SPECIAL ED
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:SUE
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS IN SPECIAL ED
Mailing Address - Street 1:301 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1636
Mailing Address - Country:US
Mailing Address - Phone:845-458-8661
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1636
Practice Address - Country:US
Practice Address - Phone:845-458-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist