Provider Demographics
NPI:1487363495
Name:PAOLUCCI, HALEY MARIE
Entity type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:MARIE
Last Name:PAOLUCCI
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 1:1358 BLUE OAKS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-7040
Mailing Address - Country:US
Mailing Address - Phone:916-676-0488
Mailing Address - Fax:916-771-4370
Practice Address - Street 1:5239 FLAPJACK LN # 962
Practice Address - Street 2:
Practice Address - City:LOTUS
Practice Address - State:CA
Practice Address - Zip Code:95651-9211
Practice Address - Country:US
Practice Address - Phone:916-860-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2287997106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician