Pablo A Pagan-Rivera, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010663 Issued in IL

Practice address

1511 W Berwyn Ave
Chicago, IL 60640-2109

Phone

(312) 546-0782

NPI assigned

Nov 17, 2021

Last updated

Nov 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 15, 2022 through Jul 15, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Reconnect Psychotherapy, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1073243069
  NPD Authorized official

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

{
    "created_epoch": "1637107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1770240418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 N MICHIGAN AVE STE 1830",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606017407",
            "telephone_number": "312-546-0782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 W BERWYN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606402109",
            "telephone_number": "312-546-0782"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "180 N Michigan Ave Ste 1830",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606017407",
            "country_code": "US",
            "telephone_number": "312-546-0782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAGAN-RIVERA",
        "first_name": "PABLO",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-17",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Antonia Paez
• Laurel Anne Paffhouse
• Manasa Pagadala
• Nina Pagaduan, AGPCNP-BC, RN
• Julissa M Pagan Pena, PSYD
• Emmanuel Pagan
• Lauren Pagan, LCPC, CDVP
• Magdalena Pagan, LPC
• Jill F Pagano
• Lindsey Brianne Paganucci, APRN

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.