Provider Demographics
NPI:1093808859
Name:MILUS, PAUL ANDREW WENDELL (LCSW/MSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL ANDREW
Middle Name:WENDELL
Last Name:MILUS
Suffix:
Gender:M
Credentials:LCSW/MSW
Other - Prefix:MR
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:MILUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW/MSW
Mailing Address - Street 1:3333 CHANATE RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1707
Mailing Address - Country:US
Mailing Address - Phone:707-565-4900
Mailing Address - Fax:
Practice Address - Street 1:3333 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1707
Practice Address - Country:US
Practice Address - Phone:707-565-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS227351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical