Provider Demographics
NPI:1275839052
Name:ROUSE, PAMELA OPAL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:OPAL
Last Name:ROUSE
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 1:18 SCOTLAND RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1101
Mailing Address - Country:US
Mailing Address - Phone:716-542-9098
Mailing Address - Fax:716-686-8670
Practice Address - Street 1:605 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1044
Practice Address - Country:US
Practice Address - Phone:716-783-3224
Practice Address - Fax:716-686-8670
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY720604851041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool