Provider Demographics
NPI:1063862365
Name:ALEXANDER, PAMELA CARLSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:CARLSON
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:SHERBORN
Mailing Address - State:MA
Mailing Address - Zip Code:01770-1053
Mailing Address - Country:US
Mailing Address - Phone:215-431-6917
Mailing Address - Fax:
Practice Address - Street 1:21 ELIOT ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-6085
Practice Address - Country:US
Practice Address - Phone:508-283-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9301OtherPSYCHOLOGY LICENSE