Karen Deabbe Bagley, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

0810004683 Issued in VA

Practice address

2227 Old Bridge Rd Ste 170
Lake Ridge, VA 22192-3007

Phone

(571) 412-3500

Fax

(571) 412-3600

NPI assigned

Jan 12, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1484179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691712000000",
    "number": "1770029944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2227 OLD BRIDGE RD STE 170",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221923007",
            "telephone_number": "571-412-3500",
            "fax_number": "571-412-3600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2227 OLD BRIDGE RD STE 170",
            "city": "LAKE RIDGE",
            "state": "VA",
            "postal_code": "221923007",
            "telephone_number": "571-412-3500",
            "fax_number": "571-412-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGLEY",
        "first_name": "KAREN",
        "middle_name": "DEABBE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-12",
        "last_updated": "2023-08-11",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004683",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810004683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Lake Ridge, VA
• Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.