Provider Demographics
NPI:1114434404
Name:PAULA P. MERUCCI, LLC
Entity Type:Organization
Organization Name:PAULA P. MERUCCI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MERUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-859-6033
Mailing Address - Street 1:3425 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4953
Mailing Address - Country:US
Mailing Address - Phone:847-859-6033
Mailing Address - Fax:847-241-0305
Practice Address - Street 1:2530 CRAWFORD AVE STE 115
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4954
Practice Address - Country:US
Practice Address - Phone:847-859-6033
Practice Address - Fax:847-241-0305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149017859261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health