Provider Demographics
NPI:1508800368
Name:PAULIC, NORMA J (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:PAULIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:J
Other - Last Name:CONNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2221 N RAINBOW VISTA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-820-1931
Mailing Address - Fax:520-886-4549
Practice Address - Street 1:6041 E GRANT ROAD
Practice Address - Street 2:#101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712
Practice Address - Country:US
Practice Address - Phone:520-820-1931
Practice Address - Fax:520-886-4549
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW107641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ840240Medicaid
AZ840240Medicaid