Provider Demographics
NPI:1194805218
Name:MCLANE, PAMELA (LICSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MCLANE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:133 FALMOUTH RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-2611
Mailing Address - Country:US
Mailing Address - Phone:508-477-7499
Mailing Address - Fax:508-477-2499
Practice Address - Street 1:133 FALMOUTH RD
Practice Address - Street 2:SUITE F
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-2611
Practice Address - Country:US
Practice Address - Phone:508-477-7499
Practice Address - Fax:507-477-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1110001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23848Medicare Oscar/Certification
MAP23848Medicare ID - Type UnspecifiedMEDICARE PROVIDER