Healthcare Provider Details

I. General information

NPI: 1972581569
Provider Name (Legal Business Name): INGRID BIRUM PAULI PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 475 BOX 1
FPO AE
96350
US

IV. Provider business mailing address

PSC 475 BOX 1
FPO AE
96350
US

V. Phone/Fax

Practice location:
  • Phone: 541-412-7586
  • Fax:
Mailing address:
  • Phone: 541-412-7586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number015442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: