Provider Demographics
NPI:1356166243
Name:PAGO, SHARON (MSW, LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:PAGO
Suffix:
Gender:F
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30010 TROTTING TRL
Mailing Address - Street 2:
Mailing Address - City:RICHARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22736-1998
Mailing Address - Country:US
Mailing Address - Phone:571-221-5242
Mailing Address - Fax:
Practice Address - Street 1:10615 JUDICIAL DR STE 301
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7501
Practice Address - Country:US
Practice Address - Phone:703-667-0752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806551041C0700X
VA09040064241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical