Provider Demographics
NPI:1063920247
Name:PAULL, EMILY JEAN (PSYD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:PAULL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:JEAN
Other - Last Name:MARKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1171 LANCASTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-2602
Mailing Address - Country:US
Mailing Address - Phone:717-451-6135
Mailing Address - Fax:
Practice Address - Street 1:1171 LANCASTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-2602
Practice Address - Country:US
Practice Address - Phone:484-674-6325
Practice Address - Fax:484-674-6325
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-22
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical