Provider Demographics
NPI:1518919075
Name:TOMASOVICH, PAULETTE A (PHD)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:A
Last Name:TOMASOVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-1126
Mailing Address - Country:US
Mailing Address - Phone:724-699-2682
Mailing Address - Fax:
Practice Address - Street 1:730 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-1126
Practice Address - Country:US
Practice Address - Phone:724-699-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC01710101YM0800X
OH6304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7872392OtherAETNEA
PAPC01710OtherLICENSE NUMBER
PA317371OtherUPMC-COMMUNITY CARE
OH6304OtherOHIO LICENSE
PA1418538OtherKEYSTONE BS
OH204861187OtherTAX ID
PA552120OtherVALUE OPTION