Provider Demographics
NPI:1013097476
Name:STRAUSS, PAGAN JOHANNA (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAGAN
Middle Name:JOHANNA
Last Name:STRAUSS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4620
Mailing Address - Country:US
Mailing Address - Phone:540-661-5034
Mailing Address - Fax:434-979-1762
Practice Address - Street 1:420 3RD ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-4620
Practice Address - Country:US
Practice Address - Phone:540-661-5034
Practice Address - Fax:434-979-1762
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003389103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010147352Medicaid
VA187161OtherBCBS ANTHEM
VA007104C90Medicare ID - Type UnspecifiedMED