Provider Demographics
NPI:1700924875
Name:BAGLIO, BEVERLY PATRICIA
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:PATRICIA
Last Name:BAGLIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:POLOWNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:946 UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:E AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052
Mailing Address - Country:US
Mailing Address - Phone:716-687-1198
Mailing Address - Fax:716-687-1198
Practice Address - Street 1:2800 SWEETHOME RD
Practice Address - Street 2:# 8
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228
Practice Address - Country:US
Practice Address - Phone:716-479-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0233091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
00025502401AN6024OtherUNIVERA
000526355002OtherBLUE CROSS BLUE SHIELD
6290294OtherIHA
6290294OtherIHA