Provider Demographics
NPI:1902564644
Name:PAGANO, SALVATORE J
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:J
Last Name:PAGANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 S OLD ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-4250
Mailing Address - Country:US
Mailing Address - Phone:314-406-2311
Mailing Address - Fax:
Practice Address - Street 1:328 S OLD ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4250
Practice Address - Country:US
Practice Address - Phone:314-406-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016015347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health