Provider Demographics
NPI:1801548110
Name:SYRACUSE, PAULINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAULINA
Middle Name:
Last Name:SYRACUSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6725 RIDGE AVE APT 411
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2442
Mailing Address - Country:US
Mailing Address - Phone:973-934-1788
Mailing Address - Fax:
Practice Address - Street 1:63 W LANCASTER AVE STE 5
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1413
Practice Address - Country:US
Practice Address - Phone:610-645-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program