Provider Demographics
NPI:1205457421
Name:DICHIARA, PAULA CHRISTINA (LMFT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:CHRISTINA
Last Name:DICHIARA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6388 LONGLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-7008
Mailing Address - Country:US
Mailing Address - Phone:386-304-0896
Mailing Address - Fax:
Practice Address - Street 1:6388 LONGLAKE DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-7008
Practice Address - Country:US
Practice Address - Phone:386-304-0896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMT3116OtherLMFT