Provider Demographics
NPI:1336508027
Name:MUNOZ, PAOLA ANDREA (PSYD, MACJ)
Entity Type:Individual
Prefix:DR
First Name:PAOLA
Middle Name:ANDREA
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:PSYD, MACJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 SEVILLE ST # 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3630
Mailing Address - Country:US
Mailing Address - Phone:301-219-2718
Mailing Address - Fax:
Practice Address - Street 1:1181 PADDOCK RD
Practice Address - Street 2:JTVCC - CONNECTIONS COMMUNITY SUPPORT PROGRAMS
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-9679
Practice Address - Country:US
Practice Address - Phone:302-653-9261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001040103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical