Provider Demographics
NPI:1689649063
Name:HUGHES-PAULLINE, MARY T (LISW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:T
Last Name:HUGHES-PAULLINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2102 E 38TH ST
Mailing Address - Street 2:PSYCHOLOGY HEALTH GROUP
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1135
Mailing Address - Country:US
Mailing Address - Phone:563-354-4049
Mailing Address - Fax:563-359-4069
Practice Address - Street 1:2102 E 38TH ST
Practice Address - Street 2:PSYCHOLOGY HEALTH GROUP
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1135
Practice Address - Country:US
Practice Address - Phone:563-354-4049
Practice Address - Fax:563-359-4069
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1108750000Medicaid
IA1108750000Medicaid