Provider Demographics
NPI:1275839052
Name:ROUSE, PAMELA OPAL (LMSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:OPAL
Last Name:ROUSE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CLOISTER CT
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4105
Mailing Address - Country:US
Mailing Address - Phone:716-777-1588
Mailing Address - Fax:
Practice Address - Street 1:3 CLOISTER CT
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4105
Practice Address - Country:US
Practice Address - Phone:716-777-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060485-01104100000X
NY720604851041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool