Provider Demographics
NPI:1396058327
Name:NILSSON, PAMELA M (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:NILSSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 248
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5560
Mailing Address - Country:US
Mailing Address - Phone:216-299-6843
Mailing Address - Fax:216-920-6288
Practice Address - Street 1:23811 CHAGRIN BLVD STE 248
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5560
Practice Address - Country:US
Practice Address - Phone:216-789-3878
Practice Address - Fax:216-920-6288
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical