Provider Demographics
NPI:1639283005
Name:PAGANELLI, ROBERT E (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:PAGANELLI
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 1:635 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2226
Mailing Address - Country:US
Mailing Address - Phone:315-671-2946
Mailing Address - Fax:
Practice Address - Street 1:635 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2226
Practice Address - Country:US
Practice Address - Phone:315-671-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0072523101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01649605Medicaid
NY01649605Medicaid