Healthcare Provider Details

I. General information

NPI: 1912672460
Provider Name (Legal Business Name): LORRAYNE ASSIS PAULINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CANAL ST
MALDEN MA
02148-6701
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 781-338-0055
  • Fax:
Mailing address:
  • Phone: 617-355-8593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number000227115
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number127160
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000227115
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: