Provider Demographics
NPI:1922440668
Name:PAULO, ANJELICA M (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:ANJELICA
Middle Name:M
Last Name:PAULO
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 SAN JOSE PL
Mailing Address - Street 2:SUITE #22
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-2436
Mailing Address - Country:US
Mailing Address - Phone:904-928-0112
Mailing Address - Fax:904-928-0112
Practice Address - Street 1:3771 SAN JOSE PL
Practice Address - Street 2:SUITE #22
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-2436
Practice Address - Country:US
Practice Address - Phone:904-928-0112
Practice Address - Fax:904-928-0112
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-15-19484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst