Provider Demographics
NPI:1285216614
Name:KERN, PAMELA JEAN (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:KERN
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JEAN
Other - Last Name:KERN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:314 ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3102
Mailing Address - Country:US
Mailing Address - Phone:207-530-5389
Mailing Address - Fax:
Practice Address - Street 1:314 ALFRED ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3102
Practice Address - Country:US
Practice Address - Phone:207-370-5389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELSX185721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical