Provider Demographics
NPI:1467431163
Name:PARADISO, JOHN MORGAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MORGAN
Last Name:PARADISO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5493
Mailing Address - Country:US
Mailing Address - Phone:757-385-0684
Mailing Address - Fax:757-493-5456
Practice Address - Street 1:289 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 245
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5493
Practice Address - Country:US
Practice Address - Phone:757-385-0835
Practice Address - Fax:757-518-9713
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003025101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8942358Medicaid
VA8942358Medicaid
800002973Medicare ID - Type Unspecified