Provider Demographics
NPI:1538183314
Name:PAGANO, LORI ANN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:LORI
Middle Name:ANN
Last Name:PAGANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:LORI
Other - Middle Name:ANN
Other - Last Name:PAGANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:342 OLD TOWN RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3452
Mailing Address - Country:US
Mailing Address - Phone:516-317-9710
Mailing Address - Fax:
Practice Address - Street 1:342 OLD TOWN RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3452
Practice Address - Country:US
Practice Address - Phone:516-317-9710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0702561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6X381Medicare ID - Type Unspecified