Provider Demographics
NPI:1033326871
Name:GLIDDEN, PAMELA RUST (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:RUST
Last Name:GLIDDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:228 BURLEIGH RD
Mailing Address - City:WESTFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04787-0057
Mailing Address - Country:US
Mailing Address - Phone:207-425-1002
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2126
Practice Address - Country:US
Practice Address - Phone:207-532-5510
Practice Address - Fax:207-532-5518
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MELCSW 121211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME417140099Medicaid