Provider Demographics
NPI:1851801559
Name:PAULINO, DOMINGO (MSW)
Entity Type:Individual
Prefix:
First Name:DOMINGO
Middle Name:
Last Name:PAULINO
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S HARRISON ST APT 14J
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07018-1329
Mailing Address - Country:US
Mailing Address - Phone:917-570-3960
Mailing Address - Fax:
Practice Address - Street 1:320 S HARRISON ST APT 14J
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07018-1329
Practice Address - Country:US
Practice Address - Phone:917-570-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ104100000X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty