Provider Demographics
NPI:1487162194
Name:MARTORANO-PAGNOTTA, JOLENE IRENE
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:IRENE
Last Name:MARTORANO-PAGNOTTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1597 COLE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3414
Mailing Address - Country:US
Mailing Address - Phone:303-424-6078
Mailing Address - Fax:
Practice Address - Street 1:1597 COLE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3414
Practice Address - Country:US
Practice Address - Phone:303-424-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)