Provider Demographics
NPI:1568413490
Name:MCNITT, PAULA C (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:C
Last Name:MCNITT
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 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:200 LERNA RD S
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9388
Practice Address - Country:US
Practice Address - Phone:217-258-5900
Practice Address - Fax:217-258-3686
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070-003710Medicaid
IL070-003710Medicaid
ILK11694Medicare PIN