Provider Demographics
NPI:1689790040
Name:PAGANO, JUSTINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:
Last Name:PAGANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 MONTGOMERY CROSSWAY
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-1606
Mailing Address - Country:US
Mailing Address - Phone:914-965-9505
Mailing Address - Fax:
Practice Address - Street 1:121 WESTMORELAND AVENUE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606
Practice Address - Country:US
Practice Address - Phone:914-949-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR057392-11041C0700X
NYR0573921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN39V71Medicare ID - Type Unspecified