Provider Demographics
NPI:1346274032
Name:MUNI, PAULETTE G (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:G
Last Name:MUNI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:G
Other - Last Name:MUNI-BRANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 23794
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29224-3794
Mailing Address - Country:US
Mailing Address - Phone:803-462-1313
Mailing Address - Fax:803-462-1390
Practice Address - Street 1:9711 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:SC
Practice Address - Zip Code:29061-9148
Practice Address - Country:US
Practice Address - Phone:803-462-1313
Practice Address - Fax:803-462-1390
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009578-1103T00000X
SC1007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0520Medicaid
SCP01149077Medicare Oscar/Certification
SCQ35920B377Medicare PIN