Provider Demographics
NPI:1154741593
Name:MASSIE, PAMELA LOU (MSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LOU
Last Name:MASSIE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N ROYAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-7845
Mailing Address - Country:US
Mailing Address - Phone:812-402-0020
Mailing Address - Fax:812-402-0023
Practice Address - Street 1:1101 N ROYAL AVE STE B
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-7845
Practice Address - Country:US
Practice Address - Phone:812-402-0020
Practice Address - Fax:812-402-0023
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker