Provider Demographics
NPI:1710942404
Name:PAGONIS, IRENE CAROL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:CAROL
Last Name:PAGONIS
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 1:401 SHADY AVE
Mailing Address - Street 2:SUITE A-205
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-362-4999
Mailing Address - Fax:
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE A-205
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-362-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical