Provider Demographics
NPI:1376824011
Name:MARTIN, PAMELA KAY
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:KAY
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9438 OLNEY ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2047
Mailing Address - Country:US
Mailing Address - Phone:562-686-4348
Mailing Address - Fax:
Practice Address - Street 1:1245 E WALNUT ST
Practice Address - Street 2:SUITE 117
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1878
Practice Address - Country:US
Practice Address - Phone:626-795-9128
Practice Address - Fax:626-795-0975
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)