Healthcare Provider Details

I. General information

NPI: 1225430085
Provider Name (Legal Business Name): PAULA AGNELLO GOLDSTEIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 W 8 MILE RD
FERNDALE MI
48220-2100
US

IV. Provider business mailing address

10300 W 8 MILE RD
FERNDALE MI
48220-2100
US

V. Phone/Fax

Practice location:
  • Phone: 248-398-3200
  • Fax:
Mailing address:
  • Phone: 248-398-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704176732
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704176732
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: