MEDICARE: DR. PAULA JOAN JEAN PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	08100001202	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083687412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA JOAN JEAN PHD

Provider Business Mailing Address
First Line	:	1441 VILLAGE POND LN APT 1406
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-3496
Country	:	US
Telephone Number	:	804-318-5211
Fax Number	:	804-369-9709

Provider Business Practice Location Address
First Line	:	1441 VILLAGE POND LN APT 1406
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-3496
Country	:	US
Telephone Number	:	804-318-5211
Fax Number	:	804-369-9709

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	02/04/2025

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