Healthcare Provider Details

I. General information

NPI: 1811419336
Provider Name (Legal Business Name): JAMES VINCENT-PATRICK DAGOSTINO MA, LLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28175 HAGGERTY RD
NOVI MI
48377-2903
US

IV. Provider business mailing address

28175 HAGGERTY RD
NOVI MI
48377-2903
US

V. Phone/Fax

Practice location:
  • Phone: 630-313-2575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361007581
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: