Provider Demographics
NPI:1679071385
Name:PAUL, JOSIE L (MA)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:L
Last Name:PAUL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:L
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4737 N KILPATRICK AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4027
Mailing Address - Country:US
Mailing Address - Phone:773-354-8208
Mailing Address - Fax:
Practice Address - Street 1:4737 N KILPATRICK AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4027
Practice Address - Country:US
Practice Address - Phone:773-354-8208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490077311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical