Provider Demographics
NPI:1306975065
Name:KAWANO, PAMELA BAMPTON (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BAMPTON
Last Name:KAWANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 PHEASANT HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PLAINSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08536-3508
Mailing Address - Country:US
Mailing Address - Phone:805-236-6877
Mailing Address - Fax:
Practice Address - Street 1:302 BIRCHFIELD DR
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-4005
Practice Address - Country:US
Practice Address - Phone:856-733-0832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100580600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical