Individual provider Active NPI

Deja Breanna Pagan

  • Clinical Social Worker
  • Sacramento, CA
National Provider Identifier
1255832952
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW118371 Issued in CA
Practice address
3800 Watt Ave Ste 110
Sacramento, CA 95821-2622
Phone
(916) 344-0249
NPI assigned
Feb 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X ACSW96038 CA
Clinical Social Worker 1041C0700X ASW96038 CA
Case Manager/Care Coordinator 171M00000X
Clinical Social Worker 1041C0700X LCSW118371 CA Primary

Addresses

Primary practice location

3800 Watt Ave Ste 110
Sacramento, CA 95821-2622

Mailing address

3800 Watt Ave Ste 110
Sacramento, CA 95821-2622
Phone (916) 344-0249

Other practice location 1

8912 Volunteer Ln
Sacramento, CA 95826-3221
Phone (916) 344-0199

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
ACSW96038CAMDSocial Worker
ASW96038CAMDClinical Social Worker
LCSW118371CAMDClinical Social Worker

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519689600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1255832952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 WATT AVE STE 110",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958212622",
            "telephone_number": "916-344-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 WATT AVE STE 110",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958212622",
            "telephone_number": "916-344-0249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8912 Volunteer Ln",
            "address_purpose": "LOCATION",
            "city": "Sacramento",
            "state": "CA",
            "postal_code": "958263221",
            "country_code": "US",
            "telephone_number": "916-344-0199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAGAN",
        "first_name": "DEJA",
        "middle_name": "BREANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-27",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ACSW96038",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "ASW96038",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW118371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.