Provider Demographics
NPI:1922301464
Name:BOOTHE, PAULA (MSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:BOOTHE
Suffix:
Gender:F
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:RR 1 BOX 111B
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-9405
Mailing Address - Country:US
Mailing Address - Phone:304-392-2198
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 111B
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976-9405
Practice Address - Country:US
Practice Address - Phone:304-392-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00213517104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker