Provider Demographics
NPI:1962565366
Name:MARSH, PAMELA WARNER (PSYD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:WARNER
Last Name:MARSH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 TADWORTH PL
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4016
Mailing Address - Country:US
Mailing Address - Phone:248-860-2024
Mailing Address - Fax:248-737-9963
Practice Address - Street 1:31330 NORTHWESTERN HWY
Practice Address - Street 2:SUITE D
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2560
Practice Address - Country:US
Practice Address - Phone:248-860-2024
Practice Address - Fax:248-737-9963
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011372103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68-F3-3318-0OtherBCBSM-PIN