Provider Demographics
NPI:1104124932
Name:PAGANO, THERESA C (LPC)
Entity type:Individual
Prefix:MS
First Name:THERESA
Middle Name:C
Last Name:PAGANO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BOULEVARD STE 2
Mailing Address - Street 2:
Mailing Address - City:KENILWORTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07033-1611
Mailing Address - Country:US
Mailing Address - Phone:908-965-0941
Mailing Address - Fax:908-276-5400
Practice Address - Street 1:525 BOULEVARD STE 2
Practice Address - Street 2:
Practice Address - City:KENILWORTH
Practice Address - State:NJ
Practice Address - Zip Code:07033-1611
Practice Address - Country:US
Practice Address - Phone:908-965-0941
Practice Address - Fax:908-276-5400
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00403500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional