Provider Demographics
NPI:1851742316
Name:PAGONES, TARREN (LCAT, LPC)
Entity Type:Individual
Prefix:
First Name:TARREN
Middle Name:
Last Name:PAGONES
Suffix:
Gender:F
Credentials:LCAT, LPC
Other - Prefix:
Other - First Name:TARREN
Other - Middle Name:
Other - Last Name:MANFREDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCAT, LPC
Mailing Address - Street 1:827 ROUTE 82 STE 10-259
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-7351
Mailing Address - Country:US
Mailing Address - Phone:914-487-9600
Mailing Address - Fax:
Practice Address - Street 1:827 ROUTE 82 STE 10-259
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-7351
Practice Address - Country:US
Practice Address - Phone:914-487-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-27
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY002020221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor