MEDICARE: MRS. CAROLYN PAULUS LSW, LCDC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	161014	OH
2	104100000X	Social Worker	S.0027371	OH

General Provider Information

NPI Number	:	1982120804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN PAULUS LSW, LCDC III

Provider Business Mailing Address
First Line	:	885 E BUCHTEL AVE
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44305-2338
Country	:	US
Telephone Number	:	567-220-7018
Fax Number	:	567-220-7012

Provider Business Practice Location Address
First Line	:	65 SAINT FRANCIS AVE
Second Line	:
City	:	TIFFIN
State	:	OH
Zip	:	44883-3413
Country	:	US
Telephone Number	:	567-220-7018
Fax Number	:	567-220-7012

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

Provider Enumeration Date	:	08/22/2017
Last Update Date	:	12/19/2023

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