=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356166243
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON PAGO MSW, LCSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2024
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10615 JUDICIAL DR STE 301
-----------------------------------------------------
City | FAIRFAX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22030-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-667-0752
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30010 TROTTING TRL
-----------------------------------------------------
City | RICHARDSVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22736-1998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-221-5242
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC50080655
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904006424
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------