Provider Demographics
NPI:1124368386
Name:VANSUMMERN, PAMELA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:VANSUMMERN
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 1:1499 HUNTINGTON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4552
Mailing Address - Country:US
Mailing Address - Phone:626-403-4370
Mailing Address - Fax:626-403-4260
Practice Address - Street 1:1499 HUNTINGTON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4552
Practice Address - Country:US
Practice Address - Phone:626-403-4370
Practice Address - Fax:626-403-4260
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 202411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical