Provider Demographics
NPI:1912164716
Name:ANISMAN, PAMELA A
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:ANISMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5052 DAY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6596
Mailing Address - Country:US
Mailing Address - Phone:707-437-8615
Mailing Address - Fax:
Practice Address - Street 1:5416 HOLDENER ROAD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:CA
Practice Address - Zip Code:95625
Practice Address - Country:US
Practice Address - Phone:707-453-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool