Provider Demographics
NPI:1821078106
Name:GONCE, PAULA M (BCBA, LCPC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:M
Last Name:GONCE
Suffix:
Gender:F
Credentials:BCBA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2743
Mailing Address - Country:US
Mailing Address - Phone:410-215-5160
Mailing Address - Fax:
Practice Address - Street 1:3421 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2743
Practice Address - Country:US
Practice Address - Phone:410-215-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-01-0625103K00000X
MDLC2005101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional