Provider Demographics
NPI:1487729216
Name:GOLDMAN, PAMELA JOY KLEIN
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOY KLEIN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:JOY
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1350 BELMONT STREET
Mailing Address - Street 2:SUITE #107
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4430
Mailing Address - Country:US
Mailing Address - Phone:508-584-9161
Mailing Address - Fax:508-584-9463
Practice Address - Street 1:1350 BELMONT STREET
Practice Address - Street 2:SUITE #107
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4430
Practice Address - Country:US
Practice Address - Phone:508-584-9161
Practice Address - Fax:508-584-9463
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1038691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP02196OtherBC BS
MAP02196OtherBC BS