Provider Demographics
NPI:1376888958
Name:PAGIATI, THEODORA (LP-MHC)
Entity Type:Individual
Prefix:
First Name:THEODORA
Middle Name:
Last Name:PAGIATI
Suffix:
Gender:F
Credentials:LP-MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 125TH ST
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4516
Mailing Address - Country:US
Mailing Address - Phone:212-864-4128
Mailing Address - Fax:
Practice Address - Street 1:55 W 125TH ST
Practice Address - Street 2:10TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4516
Practice Address - Country:US
Practice Address - Phone:212-864-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86543101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health