Provider Demographics
NPI:1376649236
Name:PAULUCCI, PHILIP MARK (MSW)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:MARK
Last Name:PAULUCCI
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1953 SAMADA AVE
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3471
Mailing Address - Country:US
Mailing Address - Phone:614-431-9747
Mailing Address - Fax:
Practice Address - Street 1:5151 REED ROAD
Practice Address - Street 2:BLDG C SUITE 128 CENTRAL OHIO BEHAVIORAL MEDICINE INC
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2553
Practice Address - Country:US
Practice Address - Phone:614-538-8300
Practice Address - Fax:614-538-1656
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001043101YP2500X
OHI00013901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R72272Medicare UPIN
PASW11784Medicare ID - Type Unspecified