Provider Demographics
NPI:1104895457
Name:PAUL, AMY REBECCA (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:REBECCA
Last Name:PAUL
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2520
Mailing Address - Country:US
Mailing Address - Phone:215-354-0161
Mailing Address - Fax:215-504-0661
Practice Address - Street 1:720 SECOND STREET PIKE
Practice Address - Street 2:202A
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-5902
Practice Address - Country:US
Practice Address - Phone:215-354-0161
Practice Address - Fax:215-504-0661
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000441101YM0800X
NJPC00302500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health