Provider Demographics
NPI:1083091938
Name:STANTON, PAULINE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-2847
Mailing Address - Country:US
Mailing Address - Phone:765-827-5610
Mailing Address - Fax:765-825-9440
Practice Address - Street 1:107 W 20TH ST
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2847
Practice Address - Country:US
Practice Address - Phone:765-827-5610
Practice Address - Fax:765-825-9440
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007228A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health