Provider Demographics
NPI:1205842168
Name:BRASWELL, PAMELA KAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:KAY
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 SOLANO AVE # 7
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1826
Mailing Address - Country:US
Mailing Address - Phone:415-440-6240
Mailing Address - Fax:510-295-2597
Practice Address - Street 1:1304 SOLANO AVE # 7
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1826
Practice Address - Country:US
Practice Address - Phone:415-440-6240
Practice Address - Fax:510-295-2597
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 15583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201998OtherMANAGED HEALTH NETWORK
CA51033OtherSF MENTAL HEALTH PLAN
CA51033OtherSF MENTAL HEALTH PLAN