Provider Demographics
NPI:1518031756
Name:GLENN N. PAULE-CARRES, PH.D., P.C.
Entity Type:Organization
Organization Name:GLENN N. PAULE-CARRES, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULE-CARRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-663-9250
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22604-0082
Mailing Address - Country:US
Mailing Address - Phone:540-667-0461
Mailing Address - Fax:540-662-6334
Practice Address - Street 1:124 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4114
Practice Address - Country:US
Practice Address - Phone:540-667-0461
Practice Address - Fax:540-662-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1041Medicare PIN