Provider Demographics
NPI:1083864623
Name:NUCHOLS, PAMELA S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:NUCHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GRAVES AVE
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2626
Mailing Address - Country:US
Mailing Address - Phone:203-453-8047
Mailing Address - Fax:203-453-8044
Practice Address - Street 1:36 GRAVES AVE
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2626
Practice Address - Country:US
Practice Address - Phone:203-453-8047
Practice Address - Fax:203-453-8044
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT11880085OtherFIRST HEALTH