Provider Demographics
NPI:1043364755
Name:SAGER, PAMELA SUE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:SAGER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 N MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-9099
Mailing Address - Country:US
Mailing Address - Phone:407-330-3578
Mailing Address - Fax:407-330-0397
Practice Address - Street 1:1890 STATE ROAD 436
Practice Address - Street 2:STE. 251
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2228
Practice Address - Country:US
Practice Address - Phone:407-657-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 4198101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL761934100Medicaid