Provider Demographics
NPI:1548829740
Name:PAULINO, TRACY (LMHC, MCAP, ICRC)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:PAULINO
Suffix:
Gender:F
Credentials:LMHC, MCAP, ICRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22481 SW56TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-563-5571
Mailing Address - Fax:
Practice Address - Street 1:2400 W YAMATO RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-8403
Practice Address - Country:US
Practice Address - Phone:561-241-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health