Healthcare Provider Details

I. General information

NPI: 1417344409
Provider Name (Legal Business Name): RAYMOND GREGORY BAGEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 ROUTE 55 STE 10
LAGRANGEVILLE NY
12540-5052
US

IV. Provider business mailing address

1133 ROUTE 55 STE 10
LAGRANGEVILLE NY
12540-5052
US

V. Phone/Fax

Practice location:
  • Phone: 914-589-3434
  • Fax:
Mailing address:
  • Phone: 914-589-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number007926
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: