Provider Demographics
NPI:1588891493
Name:JENNINGS, PAMELA SUE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:JENNINGS
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 1:1740 OCEAN AVE APT 5G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5451
Mailing Address - Country:US
Mailing Address - Phone:718-951-0761
Mailing Address - Fax:
Practice Address - Street 1:1740 OCEAN AVE APT 5G
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5451
Practice Address - Country:US
Practice Address - Phone:718-951-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical