Provider Demographics
NPI:1588007512
Name:DAINE, PAULA PATRICIA (MA, LICSW)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:PATRICIA
Last Name:DAINE
Suffix:
Gender:F
Credentials:MA, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 YORK AVE S STE 417
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2336
Mailing Address - Country:US
Mailing Address - Phone:952-426-3034
Mailing Address - Fax:612-807-1773
Practice Address - Street 1:6550 YORK AVE S STE 417
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2336
Practice Address - Country:US
Practice Address - Phone:952-426-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86621041C0700X
MN086621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical