Provider Demographics
NPI:1083855522
Name:AGAN-SMITH, PAMELA V (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:V
Last Name:AGAN-SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1707
Mailing Address - Country:US
Mailing Address - Phone:518-346-0762
Mailing Address - Fax:518-346-0783
Practice Address - Street 1:101 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1707
Practice Address - Country:US
Practice Address - Phone:518-346-0762
Practice Address - Fax:518-346-0783
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist