Provider Demographics
NPI:1245568856
Name:CHAN, PAULA (BCABA)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 NETWORK PL
Mailing Address - Street 2:APT. 204D
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-3165
Mailing Address - Country:US
Mailing Address - Phone:216-870-4584
Mailing Address - Fax:
Practice Address - Street 1:2907 NETWORK PL
Practice Address - Street 2:APT. 204D
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-3165
Practice Address - Country:US
Practice Address - Phone:216-870-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-09-3582103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst