Provider Demographics
NPI:1417098104
Name:AIKEN, PAMELA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:AIKEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 VINCENT RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3827
Mailing Address - Country:US
Mailing Address - Phone:860-538-9957
Mailing Address - Fax:
Practice Address - Street 1:16 VINCENT RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3827
Practice Address - Country:US
Practice Address - Phone:860-538-9957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCTGA00000438 B000602OtherCT GENERAL ASSISTANCE
CT004052015Medicaid