Provider Demographics
NPI:1821598392
Name:GIOVANNA PAGANO LCSW
Entity Type:Organization
Organization Name:GIOVANNA PAGANO LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GIOVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:707-734-0504
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95456-0272
Mailing Address - Country:US
Mailing Address - Phone:707-734-0504
Mailing Address - Fax:
Practice Address - Street 1:327 E REDWOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-3550
Practice Address - Country:US
Practice Address - Phone:707-734-0504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW22285251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295852242Medicaid