Provider Demographics
NPI:1154191450
Name:PAULINO, BERENICE
Entity type:Individual
Prefix:
First Name:BERENICE
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1801
Mailing Address - Country:US
Mailing Address - Phone:646-744-9986
Mailing Address - Fax:
Practice Address - Street 1:45 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:BOGOTA
Practice Address - State:NJ
Practice Address - Zip Code:07603-1801
Practice Address - Country:US
Practice Address - Phone:646-744-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No252Y00000XAgenciesEarly Intervention Provider Agency