Provider Demographics
NPI:1215306733
Name:PEDJOE, PAMELA MARIE (MA,LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:PEDJOE
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:PAMARIE
Other - Middle Name:
Other - Last Name:PEDJOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,LMFT
Mailing Address - Street 1:2395 DELAWARE AVE SPC 149
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5716
Mailing Address - Country:US
Mailing Address - Phone:510-506-6208
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE STE 340
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2342
Practice Address - Country:US
Practice Address - Phone:510-506-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA88484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist