Provider Demographics
NPI:1871228064
Name:WHITE, PAULA ANNE
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 FLETCHER FARM RD
Mailing Address - Street 2:
Mailing Address - City:VERMONTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12989-3519
Mailing Address - Country:US
Mailing Address - Phone:518-524-4173
Mailing Address - Fax:
Practice Address - Street 1:50 JOHN MUNN RD
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1341
Practice Address - Country:US
Practice Address - Phone:518-891-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31528101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)