Provider Demographics
NPI:1518182450
Name:PAGANO, GREGORY A (LCSW)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:PAGANO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 5TH AVE RM 1406
Mailing Address - Street 2:SUITE 1406
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8015
Mailing Address - Country:US
Mailing Address - Phone:212-924-3485
Mailing Address - Fax:
Practice Address - Street 1:80 5TH AVE RM 1406
Practice Address - Street 2:SUITE 1406
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8015
Practice Address - Country:US
Practice Address - Phone:212-924-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0268481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN47531Medicare ID - Type UnspecifiedLICENSED CLINICAL SOCIAL