Provider Demographics
NPI:1295852242
Name:PAGANO, GIOVANNA (LCSW)
Entity Type:Individual
Prefix:
First Name:GIOVANNA
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
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:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95456-0272
Mailing Address - Country:US
Mailing Address - Phone:707-734-0504
Mailing Address - Fax:
Practice Address - Street 1:327 E REDWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3550
Practice Address - Country:US
Practice Address - Phone:707-734-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS222851041C0700X
CALCSW222851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03967FMedicaid
CA551813Medicare ID - Type Unspecified