Provider Demographics
NPI:1912345232
Name:HAZEL, PAULENE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAULENE
Middle Name:T
Last Name:HAZEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18051 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5203
Mailing Address - Country:US
Mailing Address - Phone:954-296-6633
Mailing Address - Fax:954-442-4660
Practice Address - Street 1:18051 SW 18TH ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5203
Practice Address - Country:US
Practice Address - Phone:954-296-6633
Practice Address - Fax:954-442-4660
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0807103K00000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities