Provider Demographics
NPI:1194864215
Name:PAGANELLI, CARLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:PAGANELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 BEDFORD RD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-3029
Mailing Address - Country:US
Mailing Address - Phone:914-747-2492
Mailing Address - Fax:
Practice Address - Street 1:427 BEDFORD RD
Practice Address - Street 2:SUITE 340
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-3029
Practice Address - Country:US
Practice Address - Phone:914-747-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01331201103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM3551Medicare PIN