Provider Demographics
NPI:1780320408
Name:KNEELAND, PAULA JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:KNEELAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:CHAPUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:15 ESPER AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-2415
Mailing Address - Country:US
Mailing Address - Phone:774-312-5548
Mailing Address - Fax:
Practice Address - Street 1:15 ESPER AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01602-2415
Practice Address - Country:US
Practice Address - Phone:774-312-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical