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General NPI Number Information
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NPI Number | 1750682084
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Entity Type | Organization
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Legal Business Name | JOSEPH M. GAGLIANO, LCSW, P.C.
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 660 MAIN ST
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2203
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Country | US
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Telephone | 631-828-2592
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Fax | 631-509-1839
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Provider Business Mailing Address
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Address Line | 660 MAIN ST.
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2203
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Country | US
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Telephone | 631-828-2592
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Fax | 631-509-1839
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH MICHAEL GAGLIANO
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Credential | LCSW-R
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Telephone | 631-828-2592
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R049621-1
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License Number State | NY
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