Provider Demographics
NPI:1932748928
Name:MOORMAN, PAULA
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:
Last Name:MOORMAN
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 1:25896 WATER ST
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1639
Mailing Address - Country:US
Mailing Address - Phone:615-812-7340
Mailing Address - Fax:
Practice Address - Street 1:3928 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9627
Practice Address - Country:US
Practice Address - Phone:216-440-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1902392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health