Provider Demographics
NPI:1033268990
Name:PAKULA, TERRI LYNN (MS)
Entity Type:Individual
Prefix:MS
First Name:TERRI
Middle Name:LYNN
Last Name:PAKULA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E BROADWAY
Mailing Address - Street 2:APT H-22
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2425
Mailing Address - Country:US
Mailing Address - Phone:516-295-5719
Mailing Address - Fax:
Practice Address - Street 1:1201 E BROADWAY
Practice Address - Street 2:APT H-22
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2425
Practice Address - Country:US
Practice Address - Phone:516-295-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000113-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist