Provider Demographics
NPI:1487626123
Name:PAGLIOCCA, PAULINE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULINE
Middle Name:M
Last Name:PAGLIOCCA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320545
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132-0010
Mailing Address - Country:US
Mailing Address - Phone:617-833-8793
Mailing Address - Fax:617-830-0222
Practice Address - Street 1:21 TOTMAN ST STE 203
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7564
Practice Address - Country:US
Practice Address - Phone:617-833-8793
Practice Address - Fax:617-830-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06248OtherBLUE CROSS BLUE SHIELD
MAW06248OtherBLUE CROSS BLUE SHIELD
MAW06248OtherBLUE CROSS BLUE SHIELD