Provider Demographics
NPI:1396100368
Name:FLEMING, PAMELA (CASAC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16204 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-1608
Mailing Address - Country:US
Mailing Address - Phone:718-291-4844
Mailing Address - Fax:718-291-4511
Practice Address - Street 1:16204 SOUTH RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-1608
Practice Address - Country:US
Practice Address - Phone:718-291-4844
Practice Address - Fax:718-291-4511
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18285101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)