Provider Demographics
NPI:1215011812
Name:BUDNIKAS, PAMELA ANNE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNE
Last Name:BUDNIKAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 KASSON RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-9608
Mailing Address - Country:US
Mailing Address - Phone:315-745-9533
Mailing Address - Fax:
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-253-9795
Practice Address - Fax:315-253-3255
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024346-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01405852Medicaid