Provider Demographics
NPI:1518163229
Name:WARD, PAULINE PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:PATRICIA
Last Name:WARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CLIPPER WAY
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5955
Mailing Address - Country:US
Mailing Address - Phone:562-431-6158
Mailing Address - Fax:
Practice Address - Street 1:3801 E WILLOW ST
Practice Address - Street 2:JEWISH FAMILY & CHILDREN SERVICES
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1734
Practice Address - Country:US
Practice Address - Phone:562-427-7916
Practice Address - Fax:562-427-7910
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS151091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWSW15109AMedicare ID - Type Unspecified