Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 0810003389 | VA |
Y | 103TC0700X | Clinical Psychologist | 0810003389 | VA |
NPI | 1013097476 |
---|---|
Provider Name | Dr. Pagan Johanna Strauss |
First Address | Charlottesville, VA 22902-4620 |
Second Address | Charlottesville, VA 22902-4620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 08/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010147352 | (05) | VA |
187161 | BCBS ANTHEM (01) | VA |