Provider Demographics
NPI:1497470496
Name:POBLOCKI, PAULA (LAC)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:POBLOCKI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HADDON TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08107-1834
Mailing Address - Country:US
Mailing Address - Phone:609-230-3372
Mailing Address - Fax:
Practice Address - Street 1:2301 E EVESHAM RD STE 109
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4502
Practice Address - Country:US
Practice Address - Phone:856-433-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00674400103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling