Provider Demographics
NPI:1629004734
Name:PEDAGNO, NANCY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:PEDAGNO
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:PEDAGNO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:45 OLNEY RD
Mailing Address - Street 2:
Mailing Address - City:BOURNE
Mailing Address - State:MA
Mailing Address - Zip Code:02532-5412
Mailing Address - Country:US
Mailing Address - Phone:508-743-9945
Mailing Address - Fax:
Practice Address - Street 1:PSYCHIATRIC CENTER OF CAPE COD HOSPITAL
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1135361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical