=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336508027
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAOLA ANDREA MUNOZ PSY.D., MACJ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2016
-----------------------------------------------------
Last Update Date | 02/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1181 PADDOCK RD JTVCC - CONNECTIONS COMMUNITY SUPPORT PROGRAMS
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19977-9679
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-653-9261
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 434 SEVILLE ST # 1
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19128-3630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-219-2718
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | B1-0001040
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------