Provider Demographics
NPI:1932347218
Name:BARTHOLOME, PAIGE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:
Last Name:BARTHOLOME
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 1:1493 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2236
Mailing Address - Country:US
Mailing Address - Phone:651-528-4824
Mailing Address - Fax:
Practice Address - Street 1:1539 GRAND AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-2229
Practice Address - Country:US
Practice Address - Phone:651-699-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist