Provider Demographics
NPI:1114270709
Name:JUSSIM, PAMELA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:JUSSIM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3414 BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3105
Mailing Address - Country:US
Mailing Address - Phone:862-220-6531
Mailing Address - Fax:410-585-8250
Practice Address - Street 1:3414 BANCROFT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3105
Practice Address - Country:US
Practice Address - Phone:862-220-6531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical