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General NPI Number Information
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NPI Number | 1801548110
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Entity Type | Individual
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Provider Name | PAULINA SYRACUSE PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 63 W LANCASTER AVE STE 5
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City | ARDMORE
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State | PA
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Zip | 19003-1413
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Country | US
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Telephone | 610-645-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 6725 RIDGE AVE APT 411
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City | PHILADELPHIA
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State | PA
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Zip | 19128-2442
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Country | US
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Telephone | 973-934-1788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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