Provider Demographics
NPI:1013279678
Name:ANNA PAGANELLI, MA, MFT
Entity Type:Organization
Organization Name:ANNA PAGANELLI, MA, MFT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-425-7400
Mailing Address - Street 1:340 SOQUEL AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2328
Mailing Address - Country:US
Mailing Address - Phone:831-425-7400
Mailing Address - Fax:
Practice Address - Street 1:340 SOQUEL AVE STE 107
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2328
Practice Address - Country:US
Practice Address - Phone:831-425-7400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT43441106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA549511292OtherNPII