Provider Demographics
NPI:1144367319
Name:IPPOLITO, PAULA MARIA (PHD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:MARIA
Last Name:IPPOLITO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 86TH ST APT 1J
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3326
Mailing Address - Country:US
Mailing Address - Phone:212-874-7348
Mailing Address - Fax:718-884-5307
Practice Address - Street 1:200 W 86TH ST APT 1J
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3326
Practice Address - Country:US
Practice Address - Phone:212-874-7348
Practice Address - Fax:718-884-5307
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006998-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV16271Medicare PIN
NYV16272Medicare ID - Type Unspecified