Provider Demographics
NPI:1346598646
Name:PAGAN, RENEE ANN (MA/MENTAL HEALTH)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:ANN
Last Name:PAGAN
Suffix:
Gender:F
Credentials:MA/MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 BENEVA RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2110
Mailing Address - Country:US
Mailing Address - Phone:941-315-1211
Mailing Address - Fax:941-924-4185
Practice Address - Street 1:4835 BENEVA RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2110
Practice Address - Country:US
Practice Address - Phone:941-315-1211
Practice Address - Fax:941-924-4185
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13544101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional