Provider Demographics
NPI:1861476962
Name:CAIN GORMAN, PAULA (MSSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:CAIN GORMAN
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S WHITNEY WAY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4638
Mailing Address - Country:US
Mailing Address - Phone:608-231-3191
Mailing Address - Fax:608-231-3108
Practice Address - Street 1:330 S WHITNEY WAY
Practice Address - Street 2:SUITE 304
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4638
Practice Address - Country:US
Practice Address - Phone:608-231-3191
Practice Address - Fax:608-231-3108
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI66101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39787900Medicaid
WIWI 1766003Medicare PIN
S68804Medicare UPIN