Provider Demographics
NPI:1801911219
Name:PAULILLO, BARBARA MICHELE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:MICHELE
Last Name:PAULILLO
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 1:525 MARIA CT
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903
Mailing Address - Country:US
Mailing Address - Phone:321-777-6446
Mailing Address - Fax:321-726-6727
Practice Address - Street 1:525 MARIA CT
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4768
Practice Address - Country:US
Practice Address - Phone:321-777-6446
Practice Address - Fax:321-726-6727
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73180Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER