Provider Demographics
NPI:1588007512
Name:DAINE-DE BROUX, PAULA PATRICIA (MA, LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:PATRICIA
Last Name:DAINE-DE BROUX
Suffix:
Gender:
Credentials:MA, LICSW, LCSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:PATRICIA
Other - Last Name:DAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LICSW
Mailing Address - Street 1:4240 PARK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5427
Mailing Address - Country:US
Mailing Address - Phone:612-925-6033
Mailing Address - Fax:612-925-8496
Practice Address - Street 1:2501 HANLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8786
Practice Address - Country:US
Practice Address - Phone:715-954-5300
Practice Address - Fax:715-954-5301
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86621041C0700X
WI9290-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical