Provider Demographics
NPI:1487757936
Name:VAN DOREN, PAULA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:M
Last Name:VAN DOREN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:205 AVE I
Mailing Address - Street 2:SUITE #11
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-245-6814
Mailing Address - Fax:310-540-2735
Practice Address - Street 1:205 AVE I
Practice Address - Street 2:SUITE #11
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-245-6814
Practice Address - Fax:310-540-2735
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16630104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA536399OtherVALUE OPTIONS
CA11576047OtherCAQH
CA536399OtherVALUE OPTIONS