Provider Demographics
NPI:1447568274
Name:PAUL, JEANINE L (CADC)
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:L
Last Name:PAUL
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 FRONT ST STE 490
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1742
Mailing Address - Country:US
Mailing Address - Phone:508-799-2934
Mailing Address - Fax:508-770-1732
Practice Address - Street 1:44 FRONT ST STE 490
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1742
Practice Address - Country:US
Practice Address - Phone:508-799-2934
Practice Address - Fax:508-770-1732
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1456AD101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)