Provider Demographics
NPI:1700916699
Name:FOGELBERG, PAULA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:R
Last Name:FOGELBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 4TH AVE S STE 201
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2676
Mailing Address - Country:US
Mailing Address - Phone:615-794-3788
Mailing Address - Fax:
Practice Address - Street 1:108 4TH AVE S STE 201
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2676
Practice Address - Country:US
Practice Address - Phone:615-794-3788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000001961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical