Provider Demographics
NPI:1154051241
Name:VALLEY, PAMELA LYNN (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:VALLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:V
Other - Last Name:THACHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:15 STATE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1062
Mailing Address - Country:US
Mailing Address - Phone:315-854-1090
Mailing Address - Fax:
Practice Address - Street 1:15 STATE ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1062
Practice Address - Country:US
Practice Address - Phone:315-854-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017194-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical