Provider Demographics
NPI:1063567055
Name:MINICHIELLO, PAMELA J (MS)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:MINICHIELLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5 OLD VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4610
Mailing Address - Country:US
Mailing Address - Phone:508-481-8077
Mailing Address - Fax:508-481-6680
Practice Address - Street 1:56 FRAMINGHAM RD
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3260
Practice Address - Country:US
Practice Address - Phone:508-481-8077
Practice Address - Fax:508-481-6680
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health