Provider Demographics
NPI:1881138410
Name:PAGANO, TIMOTHY PATRICK (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:PAGANO
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21ST MDG
Mailing Address - Street 2:559 VINCENT STREET
Mailing Address - City:PAFB
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1540
Mailing Address - Country:US
Mailing Address - Phone:719-556-5898
Mailing Address - Fax:
Practice Address - Street 1:21ST MDG
Practice Address - Street 2:559 VINCENT STREET
Practice Address - City:PAFB
Practice Address - State:CO
Practice Address - Zip Code:80914-1540
Practice Address - Country:US
Practice Address - Phone:719-556-5898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60902512103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist