Provider Demographics
NPI:1073064457
Name:PAMBIANCO, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:PAMBIANCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3138 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2408
Mailing Address - Country:US
Mailing Address - Phone:314-664-7600
Mailing Address - Fax:314-535-4394
Practice Address - Street 1:3138 OHIO AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-2408
Practice Address - Country:US
Practice Address - Phone:314-664-7600
Practice Address - Fax:314-535-4394
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor