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General NPI Number Information
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NPI Number | 1801358817
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Entity Type | Individual
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Provider Name | JENNIFER NYCOLE LIVELY-PAGLIUCA LCSW, CADC
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Gender | Female
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 11050 MOUNT BELVEDRE BLVD RM 1113
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City | FORT DRUM
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State | NY
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Zip | 13602
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Country | US
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Telephone | 315-772-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 11480 ENDURING FREEDOM DR.
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City | FORT DRUM
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State | NY
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Zip | 13602-5041
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Country | US
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Telephone | 315-772-4738
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8013-S
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | IC-1311
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 00758-C
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 9561-C
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 9561-C
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License Number State | NV
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