Provider Demographics
NPI:1669098059
Name:PAGLIARI, KENNEDY
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:
Last Name:PAGLIARI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BLACK CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:27813-9022
Mailing Address - Country:US
Mailing Address - Phone:252-281-1718
Mailing Address - Fax:
Practice Address - Street 1:510 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACK CREEK
Practice Address - State:NC
Practice Address - Zip Code:27813-9022
Practice Address - Country:US
Practice Address - Phone:252-281-1718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW11207451041C0700X
NCC0157461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical