Provider Demographics
NPI:1912665134
Name:BAGLIERI, MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BAGLIERI
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 1:223 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3409
Mailing Address - Country:US
Mailing Address - Phone:908-418-6104
Mailing Address - Fax:
Practice Address - Street 1:277 GROVE ST STE 202
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-3601
Practice Address - Country:US
Practice Address - Phone:201-409-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-05
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213-082103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling