Provider Demographics
NPI:1295144475
Name:BRIAN PAGAN RECOVERY SOLUTIONS, PLLC
Entity type:Organization
Organization Name:BRIAN PAGAN RECOVERY SOLUTIONS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ODELL
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RMHCI
Authorized Official - Phone:561-320-6992
Mailing Address - Street 1:4400 N FEDERAL HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5195
Mailing Address - Country:US
Mailing Address - Phone:954-696-4001
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 210
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5195
Practice Address - Country:US
Practice Address - Phone:954-696-4001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12589305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service