MEDICARE: JESSICA PAGAN LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker	121907	MA

General Provider Information

NPI Number	:	1174898837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA PAGAN LICSW

Provider Business Mailing Address
First Line	:	859 WILLARD ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-7482
Country	:	US
Telephone Number	:	617-847-1950
Fax Number	:	617-774-1490

Provider Business Practice Location Address
First Line	:	532 PAGE ST
Second Line	:
City	:	STOUGHTON
State	:	MA
Zip	:	02072-6003
Country	:	US
Telephone Number	:	617-334-3663
Fax Number	:	617-553-9583

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	06/16/2020

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Directions to “ JESSICA PAGAN LICSW” Practice Location

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