Provider Demographics
NPI:1528358769
Name:COOLICAN, PAUL (MSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:COOLICAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MONTA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-1479
Mailing Address - Country:US
Mailing Address - Phone:716-491-1104
Mailing Address - Fax:
Practice Address - Street 1:17 MONTA VISTA CT
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-1479
Practice Address - Country:US
Practice Address - Phone:716-491-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029854-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical