Provider Demographics
NPI:1760980353
Name:HUGENS, PAUL BROOKE (MA)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:BROOKE
Last Name:HUGENS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 SW EAST LOUISE CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2805
Mailing Address - Country:US
Mailing Address - Phone:772-708-6933
Mailing Address - Fax:
Practice Address - Street 1:613 SW CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2924
Practice Address - Country:US
Practice Address - Phone:772-708-6933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-29
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty