Provider Demographics
NPI:1093813420
Name:SPELLMAN, PAMELA C (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:C
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:PINE FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:19548-0239
Mailing Address - Country:US
Mailing Address - Phone:610-378-5300
Mailing Address - Fax:610-378-5301
Practice Address - Street 1:505 PENN ST
Practice Address - Street 2:MAIN LEVEL
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3473
Practice Address - Country:US
Practice Address - Phone:610-378-5300
Practice Address - Fax:610-378-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015510101Y00000X, 101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1016748460002Medicaid
PA1016748460003Medicaid
PA1016748460001Medicaid
PA1016748460001Medicaid