Provider Demographics
NPI:1972700557
Name:SHIFTER, PAMELA BETH (PHD LCSW)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:BETH
Last Name:SHIFTER
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 STABLEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6095
Mailing Address - Country:US
Mailing Address - Phone:314-583-0284
Mailing Address - Fax:314-434-7429
Practice Address - Street 1:677 N NEW BALLAS RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6732
Practice Address - Country:US
Practice Address - Phone:314-583-0284
Practice Address - Fax:314-434-7429
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0010221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000078061Medicare PIN