Provider Demographics
NPI:1861514598
Name:PAUL, SOCORRO
Entity type:Individual
Prefix:MS
First Name:SOCORRO
Middle Name:
Last Name:PAUL
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 1:8951 E HAWTHORN LN
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-9154
Mailing Address - Country:US
Mailing Address - Phone:520-515-2800
Mailing Address - Fax:520-515-2877
Practice Address - Street 1:8951 E HAWTHORN LN
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615-9154
Practice Address - Country:US
Practice Address - Phone:520-515-2800
Practice Address - Fax:520-515-2877
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD04833615101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool