Provider Demographics
NPI:1992810600
Name:WEISSMAN, PAMELA (MSW, LCSW, LMFT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:WEISSMAN
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8935 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5379
Mailing Address - Country:US
Mailing Address - Phone:317-844-9907
Mailing Address - Fax:317-844-9930
Practice Address - Street 1:8935 N MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5379
Practice Address - Country:US
Practice Address - Phone:317-844-9907
Practice Address - Fax:317-844-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35000371106H00000X
IN34000806104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182982OtherANTHEM ID NUMBER