Provider Demographics
NPI:1942748694
Name:MPDC
Entity Type:Organization
Organization Name:MPDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAGANO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:973-744-5571
Mailing Address - Street 1:5 ROOSEVELT PL STE B2
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3366
Mailing Address - Country:US
Mailing Address - Phone:973-744-5571
Mailing Address - Fax:
Practice Address - Street 1:5 ROOSEVELT PL STE B2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3366
Practice Address - Country:US
Practice Address - Phone:973-744-5571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00193600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty