Provider Demographics
NPI:1134940786
Name:PAOLI, SAMUEL (LPC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:PAOLI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3015
Mailing Address - Country:US
Mailing Address - Phone:302-490-7604
Mailing Address - Fax:
Practice Address - Street 1:405 OLD DUPONT RD STE 2
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19804-1258
Practice Address - Country:US
Practice Address - Phone:302-490-7604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health