Provider Demographics
NPI:1285762112
Name:TROMPETER, PAMELA MONACO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:MONACO
Last Name:TROMPETER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1137 HARRISON AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2468
Mailing Address - Country:US
Mailing Address - Phone:850-381-1439
Mailing Address - Fax:850-215-8551
Practice Address - Street 1:1137 HARRISON AVE STE 5
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2468
Practice Address - Country:US
Practice Address - Phone:850-381-1439
Practice Address - Fax:850-215-8551
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW78431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ095COtherBLUE CROSS
FL767952100Medicaid
FL767952100Medicaid
FLZ095COtherBLUE CROSS