Provider Demographics
NPI:1447501630
Name:PAOLINO, CAMILLE (SLP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:PAOLINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 W MOUNT PLEASANT AVE
Mailing Address - Street 2:203
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2900
Mailing Address - Country:US
Mailing Address - Phone:973-994-4468
Mailing Address - Fax:973-994-4412
Practice Address - Street 1:66 W MOUNT PLEASANT AVE
Practice Address - Street 2:203
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2900
Practice Address - Country:US
Practice Address - Phone:973-994-4468
Practice Address - Fax:973-994-4412
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS001102500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist