=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598047284
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA DENISE JONES LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2011
-----------------------------------------------------
Last Update Date | 09/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 REISTERSTOWN RD SUITE 404
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-588-5048
-----------------------------------------------------
Fax | 443-853-1895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8500 LIBERTY RD
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133-4818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-742-9181
-----------------------------------------------------
Fax | 410-545-0178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 04872
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------