Provider Demographics
NPI:1669734265
Name:PAGAN, JULISSA M (LMSW)
Entity type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:M
Last Name:PAGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JULISSA
Other - Middle Name:M
Other - Last Name:VALLENAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2600
Mailing Address - Country:US
Mailing Address - Phone:631-741-2332
Mailing Address - Fax:
Practice Address - Street 1:47 HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4022
Practice Address - Country:US
Practice Address - Phone:516-496-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078957-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker