Provider Demographics
NPI:1114029568
Name:ROOT-BAECHLE, PAMELA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JANE
Last Name:ROOT-BAECHLE
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 1:408 UNION ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-1518
Mailing Address - Country:US
Mailing Address - Phone:814-695-2776
Mailing Address - Fax:814-693-9865
Practice Address - Street 1:509 ALLEGHENY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2012
Practice Address - Country:US
Practice Address - Phone:814-695-2776
Practice Address - Fax:814-693-9865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-002127-L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health