Provider Demographics
NPI:1710592142
Name:PAGANO, BRUCE F II (LCPC, NCC)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:F
Last Name:PAGANO
Suffix:II
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 3RD ST S STE 103
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-3917
Mailing Address - Country:US
Mailing Address - Phone:208-606-2783
Mailing Address - Fax:
Practice Address - Street 1:1217 3RD ST S STE 103
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3917
Practice Address - Country:US
Practice Address - Phone:208-606-2783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-7594101YM0800X
ID611935432101YS0200X
IDLPC-7594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool