Provider Demographics
NPI:1174197792
Name:WHITEHEAD, PAMELA K
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08312-1436
Mailing Address - Country:US
Mailing Address - Phone:732-330-8860
Mailing Address - Fax:
Practice Address - Street 1:150 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08312-1436
Practice Address - Country:US
Practice Address - Phone:732-330-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator