Provider Demographics
NPI:1376876573
Name:WRONA, PAMELA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:S
Last Name:WRONA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 W GRANT LINE RD
Mailing Address - Street 2:SUITE 217
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7309
Mailing Address - Country:US
Mailing Address - Phone:209-597-1122
Mailing Address - Fax:209-229-4170
Practice Address - Street 1:2180 W GRANT LINE RD
Practice Address - Street 2:SUITE 217
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7309
Practice Address - Country:US
Practice Address - Phone:209-597-1122
Practice Address - Fax:209-229-4170
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA25798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor