Provider Demographics
NPI:1942561055
Name:PAGLIUCAJOHNSON, TRISHA CONSTANCE (MSED TSHH)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:CONSTANCE
Last Name:PAGLIUCAJOHNSON
Suffix:
Gender:F
Credentials:MSED TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W DEER TRL
Mailing Address - Street 2:
Mailing Address - City:PAWLING
Mailing Address - State:NY
Mailing Address - Zip Code:12564-2170
Mailing Address - Country:US
Mailing Address - Phone:845-855-0467
Mailing Address - Fax:
Practice Address - Street 1:90 W DEER TRL
Practice Address - Street 2:
Practice Address - City:PAWLING
Practice Address - State:NY
Practice Address - Zip Code:12564-2170
Practice Address - Country:US
Practice Address - Phone:845-855-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY651967052174400000X
NY5195061174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5195061OtherNYS DEPT OF EDUCTION
NY651967052OtherNYS DEPT OF EDUCATION