Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 590 | WY |
NPI | 1114233004 |
---|---|
Provider Name | Dr. Louis A Pagano JR. |
First Address | Peterson Afb, CO 80914-1540 |
Second Address | Peterson Afb, CO 80914-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2010 |
Last Update Date | 17/03/2018 |