Provider Demographics
NPI:1619037801
Name:PAULL, LYNDA B (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNDA
Middle Name:B
Last Name:PAULL
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 1:3736 HENRY HUDSON PARKWAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1502
Mailing Address - Country:US
Mailing Address - Phone:718-543-8907
Mailing Address - Fax:718-543-8907
Practice Address - Street 1:3736 HENRY HUDSON PARKWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-543-8907
Practice Address - Fax:718-543-8907
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147251OtherVALUE OPTIONS
NYV49001Medicare ID - Type Unspecified