MEDICARE: MS. LAURA ANNE PAGAN L.C.S.W.

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	1041C0700X	Clinical Social Worker	071786-1	NY

General Provider Information

NPI Number	:	1295900199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA ANNE PAGAN L.C.S.W.

Provider Business Mailing Address
First Line	:	777 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3409
Country	:	US
Telephone Number	:	917-743-1565
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 SEAVIEW AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3409
Country	:	US
Telephone Number	:	917-743-1565
Fax Number	:

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

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	05/03/2024

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