Provider Demographics
NPI:1437376084
Name:DONLEAVY, PAMELA L (JD, NCPSYA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:DONLEAVY
Suffix:
Gender:F
Credentials:JD, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6233
Mailing Address - Country:US
Mailing Address - Phone:781-777-1940
Mailing Address - Fax:
Practice Address - Street 1:72 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6233
Practice Address - Country:US
Practice Address - Phone:781-777-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000217102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst