Provider Demographics
NPI:1174668578
Name:ADAMS MISH, PAMELA LYNNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNNE
Last Name:ADAMS MISH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HAZELWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330
Mailing Address - Country:US
Mailing Address - Phone:860-822-6009
Mailing Address - Fax:860-822-6009
Practice Address - Street 1:7 HAZELWOOD DRIVE
Practice Address - Street 2:72 ROUTE 32
Practice Address - City:FRANKLIN
Practice Address - State:CT
Practice Address - Zip Code:06254
Practice Address - Country:US
Practice Address - Phone:860-822-6009
Practice Address - Fax:860-822-6009
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000816106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist