| Bagdade And Associates, Llc | |
|
2945 Hazelwood St Ste 200 Maplewood MN 55109-1243 | |
| (651) 471-9419 | |
| (651) 326-3626 |
| Full Name | Bagdade And Associates, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 2945 Hazelwood St Ste 200, Maplewood, Minnesota |
| Authorized Official Name and Position | Paul Steven Bagdade (LICENSED PSYCHOLOGIST/PRINCIPAL OWN) |
| Authorized Official Contact | 6514719419 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bagdade And Associates, Llc 2945 Hazelwood St Ste 200 Maplewood MN 55109-1243 Ph: (651) 417-9419 | Bagdade And Associates, Llc 2945 Hazelwood St Ste 200 Maplewood MN 55109-1243 Ph: (651) 471-9419 |
| NPI Number | 1396040911 |
|---|---|
| Provider Enumeration Date | 01/12/2011 |
| Last Update Date | 10/26/2020 |
| Certification Date | 10/26/2020 |
| Medicare PECOS PAC ID | 6103004197 |
|---|---|
| Medicare Enrollment ID | O20110622000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396040911 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP 4527 (Minnesota) | Secondary |
| 103TC0700X | Psychologist - Clinical | LP4527 (Minnesota) | Primary |
| Provider Name | Paul S Bagdade |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1699785196 PECOS PAC ID: 1456383603 Enrollment ID: I20050908000467 |
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