Provider Demographics
NPI:1760419352
Name:KIRCHER, PAULA A (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:KIRCHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 KINGSLEY AVE
Mailing Address - Street 2:BLDG 14
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4535
Mailing Address - Country:US
Mailing Address - Phone:904-264-6977
Mailing Address - Fax:904-269-0870
Practice Address - Street 1:1543 KINGSLEY AVE
Practice Address - Street 2:BLDG 14
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4535
Practice Address - Country:US
Practice Address - Phone:904-264-6977
Practice Address - Fax:904-269-0870
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW46401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9693ZMedicare ID - Type Unspecified
P45365Medicare UPIN