Provider Demographics
NPI:1295404069
Name:PAIXAO, THALIA G
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:G
Last Name:PAIXAO
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 1:400 DOANSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-5902
Mailing Address - Country:US
Mailing Address - Phone:845-279-2995
Mailing Address - Fax:845-279-3077
Practice Address - Street 1:400 DOANSBURG RD
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-5902
Practice Address - Country:US
Practice Address - Phone:845-279-2995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-05-20
Deactivation Date:2024-03-13
Deactivation Code:
Reactivation Date:2024-05-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist