Provider Demographics
NPI:1508931874
Name:MADRID, PAULA A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:A
Last Name:MADRID
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NY
Mailing Address - Zip Code:07603
Mailing Address - Country:US
Mailing Address - Phone:860-982-5864
Mailing Address - Fax:
Practice Address - Street 1:255 W 93RD ST
Practice Address - Street 2:SUITE 1N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7318
Practice Address - Country:US
Practice Address - Phone:860-983-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical