Provider Demographics
NPI:1972290690
Name:PAOLINO, ANN MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:PAOLINO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SAN MARCO DR
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2544
Mailing Address - Country:US
Mailing Address - Phone:954-895-1088
Mailing Address - Fax:
Practice Address - Street 1:410 SAN MARCO DR
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2544
Practice Address - Country:US
Practice Address - Phone:954-895-1088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical