Provider Demographics
NPI:1366594137
Name:FARKAS, PAMELA ROYE (LCSW LICENSED CLINIC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ROYE
Last Name:FARKAS
Suffix:
Gender:F
Credentials:LCSW LICENSED CLINIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 COREYELL PLACE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:818-503-3600
Mailing Address - Fax:310-652-8264
Practice Address - Street 1:8415 COREYELL PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1024
Practice Address - Country:US
Practice Address - Phone:818-503-3600
Practice Address - Fax:310-652-8264
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS126331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW12633Medicare ID - Type Unspecified