Provider Demographics
NPI:1689716110
Name:FOLLANSBEE, PAUL DAVID (M DIV LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAVID
Last Name:FOLLANSBEE
Suffix:
Gender:M
Credentials:M DIV LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SUMMIT STREET
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-4222
Mailing Address - Country:US
Mailing Address - Phone:609-443-4028
Mailing Address - Fax:609-443-4028
Practice Address - Street 1:295 PIERSON AVENUE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837-3118
Practice Address - Country:US
Practice Address - Phone:732-494-8558
Practice Address - Fax:732-494-8969
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00857600101Y00000X, 101YM0800X, 101YP1600X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
183478OtherMHN
P3391943OtherOXFORD
017166Medicare ID - Type Unspecified