Provider Demographics
NPI:1215605746
Name:PAULUS, MONIKA CHARLOTTE
Entity Type:Individual
Prefix:MS
First Name:MONIKA
Middle Name:CHARLOTTE
Last Name:PAULUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SYCAMORE AVE STE 39
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-1736
Mailing Address - Country:US
Mailing Address - Phone:631-758-8290
Mailing Address - Fax:
Practice Address - Street 1:1650 SYCAMORE AVE STE 39
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-1736
Practice Address - Country:US
Practice Address - Phone:631-758-8290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003502101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health