Provider Demographics
NPI:1134838295
Name:RAINEY, PAULA J (LAC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:RAINEY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:JJEAN
Other - Last Name:RAINEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAULA WISNIEWSKI
Mailing Address - Street 1:1 VANDERVEER DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-3113
Mailing Address - Country:US
Mailing Address - Phone:609-647-0714
Mailing Address - Fax:
Practice Address - Street 1:1 VANDERVEER DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-3113
Practice Address - Country:US
Practice Address - Phone:609-647-0714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00685600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health