Provider Demographics
NPI:1962534008
Name:KLIMINSKI, PAULETTE MARY
Entity type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:MARY
Last Name:KLIMINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PAULETTE
Other - Middle Name:MARY
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:7 SPARROW DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4513
Mailing Address - Country:US
Mailing Address - Phone:973-202-9374
Mailing Address - Fax:
Practice Address - Street 1:65 JAY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-3235
Practice Address - Country:US
Practice Address - Phone:973-202-9374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00270600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6649904Medicaid
NJ6649904Medicaid