Provider Demographics
NPI:1730946310
Name:NOVOA RUSINQUE, PAOLA ANDREA
Entity type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:ANDREA
Last Name:NOVOA RUSINQUE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 WHITEFIELD DR APT 119
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-2084
Mailing Address - Country:US
Mailing Address - Phone:407-624-9693
Mailing Address - Fax:
Practice Address - Street 1:2985 BOSQUE AVE APT 405
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4423
Practice Address - Country:US
Practice Address - Phone:407-624-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health