Provider Demographics
NPI:1801505466
Name:GAGLIARDO, PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GAGLIARDO
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 LINCOLN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2408
Mailing Address - Country:US
Mailing Address - Phone:774-317-8966
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1667
Practice Address - Country:US
Practice Address - Phone:774-317-8966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374K00000X, 101Y00000X, 171M00000X, 171W00000X, 172V00000X, 174H00000X, 225A00000X, 106S00000X, 171400000X
MA101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171400000XOther Service ProvidersHealth & Wellness Coach