Provider Demographics
NPI:1891046769
Name:PAULOSE, ANCY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANCY
Middle Name:
Last Name:PAULOSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 BETHLYNN CT # 1
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-4911
Mailing Address - Country:US
Mailing Address - Phone:516-739-7462
Mailing Address - Fax:
Practice Address - Street 1:826 BETHLYNN CT # 1
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-4911
Practice Address - Country:US
Practice Address - Phone:516-739-7462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720680021041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool