Provider Demographics
NPI:1407992688
Name:PAULI-RITZ, JACQUELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:PAULI-RITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 ST JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ST JOHN PLT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-4007
Mailing Address - Country:US
Mailing Address - Phone:207-834-2011
Mailing Address - Fax:207-834-2011
Practice Address - Street 1:1879 ST JOHN RD
Practice Address - Street 2:
Practice Address - City:ST JOHN PLT
Practice Address - State:ME
Practice Address - Zip Code:04743-4007
Practice Address - Country:US
Practice Address - Phone:207-834-2011
Practice Address - Fax:207-834-2011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC13911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM4532Medicare ID - Type UnspecifiedLICENSED CLINICAL SOCIAL