Healthcare Provider Details

I. General information

NPI: 1750486619
Provider Name (Legal Business Name): LORETTA NANCY PAULSON LCSW, LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 W 86TH ST STE 1A
NEW YORK NY
10024-3106
US

IV. Provider business mailing address

334 W 86TH ST STE 1A
NEW YORK NY
10024-3106
US

V. Phone/Fax

Practice location:
  • Phone: 212-595-4111
  • Fax: 917-441-3553
Mailing address:
  • Phone: 212-595-4111
  • Fax: 917-441-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR015721
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000258-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000589
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: