MEDICARE: STEPHANIE BAGATO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1023634508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE BAGATO

Provider Business Mailing Address
First Line	:	6411 S EAST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2737
Country	:	US
Telephone Number	:	317-780-5750
Fax Number	:	317-780-5755

Provider Business Practice Location Address
First Line	:	6411 S EAST ST STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-2737
Country	:	US
Telephone Number	:	317-780-5750
Fax Number	:	317-780-5755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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Directions to “ STEPHANIE BAGATO ” Practice Location

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