Provider Demographics
NPI:1750486619
Name:PAULSON, LORETTA NANCY (LCSW, LP)
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:NANCY
Last Name:PAULSON
Suffix:
Gender:F
Credentials:LCSW, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 W 86TH ST
Mailing Address - Street 2:STE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3106
Mailing Address - Country:US
Mailing Address - Phone:212-595-4111
Mailing Address - Fax:917-441-3553
Practice Address - Street 1:334 W 86TH ST
Practice Address - Street 2:STE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3106
Practice Address - Country:US
Practice Address - Phone:212-595-4111
Practice Address - Fax:917-441-3553
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0157211041C0700X
NY000258-1102L00000X
CT0005891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYLICENSE #: 000258-1OtherPSYCHOANALYST #5623568
CT000589OtherLCSW LICENSE
NYPRO15721-1OtherLCSW REGISTRATION CERTIFI