Provider Demographics
NPI:1104835107
Name:DEDIONISIO, PAULA M (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:DEDIONISIO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8760 CLARK ROAD EXT.
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510
Mailing Address - Country:US
Mailing Address - Phone:814-866-4506
Mailing Address - Fax:814-866-4612
Practice Address - Street 1:1202 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1914
Practice Address - Country:US
Practice Address - Phone:814-454-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0153161041C0700X
NY085200-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical