Provider Demographics
NPI:1386770535
Name:PAMELA CAVINESS LISW ACSW INC
Entity type:Organization
Organization Name:PAMELA CAVINESS LISW ACSW INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAVINESS
Authorized Official - Suffix:
Authorized Official - Credentials:LISW ACSW
Authorized Official - Phone:515-232-2051
Mailing Address - Street 1:600 5TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6085
Mailing Address - Country:US
Mailing Address - Phone:515-232-2051
Mailing Address - Fax:515-232-2775
Practice Address - Street 1:600 5TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6085
Practice Address - Country:US
Practice Address - Phone:515-232-2051
Practice Address - Fax:515-232-2775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA009701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0456855Medicaid