Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003271016 |
---|---|
Provider Name | Mr. Luis M Pagan |
First Address | Springfield, MA 01105-1435 |
Second Address | Springfield, MA 01105-1435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 17/12/2015 |