Provider Demographics
NPI:1235178336
Name:MCCASKILL, PAMELA ANNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANNE
Last Name:MCCASKILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5738
Mailing Address - Country:US
Mailing Address - Phone:734-416-9098
Mailing Address - Fax:734-416-0158
Practice Address - Street 1:199 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1272
Practice Address - Country:US
Practice Address - Phone:734-416-9098
Practice Address - Fax:734-416-0158
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical