Provider Demographics
NPI:1528360492
Name:HUSACK, PAULA JO (LMFT,CGP)
Entity Type:Individual
Prefix:MS
First Name:PAULA JO
Middle Name:
Last Name:HUSACK
Suffix:
Gender:F
Credentials:LMFT,CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 EL CAMINO REAL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3126
Mailing Address - Country:US
Mailing Address - Phone:650-652-6555
Mailing Address - Fax:
Practice Address - Street 1:1838 EL CAMINO REAL
Practice Address - Street 2:SUITE 203
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3126
Practice Address - Country:US
Practice Address - Phone:650-652-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT27864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist