Provider Demographics
NPI:1720054851
Name:GAGLIARDI, FRED (MSW)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:GAGLIARDI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 VERDOSA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2942
Mailing Address - Country:US
Mailing Address - Phone:719-561-1892
Mailing Address - Fax:719-553-1107
Practice Address - Street 1:4112 OUTLOOK BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-553-1081
Practice Address - Fax:719-553-1107
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9922901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical