Provider Demographics
NPI:1083890776
Name:BANFORD, PAULETTE CATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:CATHERINE
Last Name:BANFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 BRUCE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1509
Mailing Address - Country:US
Mailing Address - Phone:215-858-1388
Mailing Address - Fax:
Practice Address - Street 1:300 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-3202
Practice Address - Country:US
Practice Address - Phone:215-858-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-14
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016360103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical