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General NPI Number Information
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NPI Number | 1457378192
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Entity Type | Organization
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Legal Business Name | BARBARA M PAULILLO PSYD & ROBERT PAULILLO PSYD PA
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 525 MARIA CT.
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City | INDIALANTIC
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State | FL
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Zip | 32903-4768
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Country | US
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Telephone | 321-506-0474
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Fax | 321-726-6727
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Provider Business Mailing Address
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Address Line | 525 MARIA CT.
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City | INDIALANTIC
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State | FL
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Zip | 32903-4768
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Country | US
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Telephone | 321-506-0474
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Fax | 321-726-6727
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARBARA M PAULILLO
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Credential | PSYD
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Telephone | 321-506-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY3748
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License Number State | FL
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