MEDICARE: GIOVANNA PAGANO LCSW

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	251S00000X	Community/Behavioral Health Agency	LCSW22285	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821598392
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIOVANNA PAGANO LCSW

Provider Business Mailing Address
First Line	:	PO BOX 272
Second Line	:
City	:	LITTLE RIVER
State	:	CA
Zip	:	95456-0272
Country	:	US
Telephone Number	:	707-734-0504
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 E REDWOOD AVE STE D
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3550
Country	:	US
Telephone Number	:	707-734-0504
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MS. GIOVANNA PAGANO
Credential	:	LCSW
Telephone Number	:	707-734-0504

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	03/08/2018

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