Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 0813001033 | VA |
NPI | 1043829856 |
---|---|
Provider Name | Nicole Pagano |
First Address | Roanoke, VA 24019-2403 |
Second Address | Roanoke, VA 24019-2403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2020 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0813001033 | VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS (01) | VA |