Provider Demographics
NPI:1780003715
Name:PAOLELLA, GILLIAN NICOLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:NICOLE
Last Name:PAOLELLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:GILA
Other - Middle Name:NICOLE
Other - Last Name:PAOLELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:65 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-2035
Mailing Address - Country:US
Mailing Address - Phone:845-554-4996
Mailing Address - Fax:
Practice Address - Street 1:21 BOW ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-2933
Practice Address - Country:US
Practice Address - Phone:845-554-4996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1455171100000X
CAAC 13312171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist