Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 4168 | NJ |
Y | 103T00000X | Psychologist | 4168 | NJ |
NPI | 1013031293 |
---|---|
Provider Name | Paula B Houck |
First Address | Sparta, NJ 07871-2424 |
Second Address | Sparta, NJ 07871-2424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
797768000 | MAGELLAN (01) | NJ |