Provider Demographics
NPI:1346424355
Name:HARTVIG, PAMELA H (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:H
Last Name:HARTVIG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:H
Other - Last Name:RANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 T ST
Mailing Address - Street 2:STE,105
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-7052
Mailing Address - Country:US
Mailing Address - Phone:916-801-5805
Mailing Address - Fax:888-342-0714
Practice Address - Street 1:3000 T ST STE 105
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7052
Practice Address - Country:US
Practice Address - Phone:916-801-5805
Practice Address - Fax:888-342-0714
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS47781041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA120672Medicare PIN