Provider Demographics
NPI:1699785196
Name:BAGDADE, PAUL S (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:BAGDADE
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 HAZELWOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-1243
Mailing Address - Country:US
Mailing Address - Phone:612-440-6315
Mailing Address - Fax:651-412-5338
Practice Address - Street 1:2945 HAZELWOOD ST STE 200
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-1243
Practice Address - Country:US
Practice Address - Phone:612-440-6315
Practice Address - Fax:651-471-9442
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 4527103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN519T2BAOtherBCBS
MN093464000Medicaid
MNHP48607OtherHEALTH PARTNERS