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General NPI Number Information
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NPI Number | 1467594085
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Entity Type | Individual
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Provider Name | RICHARD G CIAGLIA MA LISAL
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1102 W HIGHLAND AVE
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City | PHOENIX
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State | AZ
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Zip | 85013-2470
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Country | US
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Telephone | 602-707-2418
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Fax | 602-707-2040
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Provider Business Mailing Address
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Address Line | 1226 W OSBORN RD
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City | PHOENIX
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State | AZ
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Zip | 85013-3618
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Country | US
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Telephone | 602-707-2418
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Fax | 602-707-2040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LSAC10488
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License Number State | AZ
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