Provider Demographics
NPI:1033838636
Name:ANDREA PAMMER LLC DBA PAMMERPSYCH
Entity Type:Organization
Organization Name:ANDREA PAMMER LLC DBA PAMMERPSYCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:304-365-2974
Mailing Address - Street 1:37 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1036
Mailing Address - Country:US
Mailing Address - Phone:304-365-2974
Mailing Address - Fax:304-367-0233
Practice Address - Street 1:1314 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1436
Practice Address - Country:US
Practice Address - Phone:304-367-0232
Practice Address - Fax:304-367-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)