Provider Demographics
NPI:1881377117
Name:PAULINO, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLARENCE AVE APT SUITE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS HDSN
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3206
Mailing Address - Country:US
Mailing Address - Phone:917-553-2119
Mailing Address - Fax:
Practice Address - Street 1:15 CLARENCE AVE APT SUITE
Practice Address - Street 2:
Practice Address - City:HASTINGS HDSN
Practice Address - State:NY
Practice Address - Zip Code:10706-3206
Practice Address - Country:US
Practice Address - Phone:917-553-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool