Provider Demographics
NPI:1366632077
Name:GOLDBERG, PAULA M (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:M
Last Name:GOLDBERG
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 1:3075 EQUESTRIAN DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3357
Mailing Address - Country:US
Mailing Address - Phone:561-488-3999
Mailing Address - Fax:
Practice Address - Street 1:12403 ROCKLEDGE CIR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:561-488-3999
Practice Address - Fax:561-892-0166
Is Sole Proprietor?:No
Enumeration Date:2007-07-29
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-02-0583222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685293996OtherMEDWAIVER
FL811855800Medicaid