Provider Demographics
NPI:1831424019
Name:QUAGLIANA, DAVID PETER (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:QUAGLIANA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3954 WILLOW BEND TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-1839
Mailing Address - Country:US
Mailing Address - Phone:773-420-6825
Mailing Address - Fax:
Practice Address - Street 1:1120 N OCOEE ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-4458
Practice Address - Country:US
Practice Address - Phone:773-420-6825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2883103T00000X, 103TC0700X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy