Provider Demographics
NPI:1073159547
Name:PAGANO, ANN MARIE
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ERIN LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6442
Mailing Address - Country:US
Mailing Address - Phone:631-456-9749
Mailing Address - Fax:
Practice Address - Street 1:5505 NESCONSET HWY STE 222
Practice Address - Street 2:
Practice Address - City:MOUNT SINAI
Practice Address - State:NY
Practice Address - Zip Code:11766-2026
Practice Address - Country:US
Practice Address - Phone:631-828-2264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician