Provider Demographics
NPI:1437468964
Name:STICH, PAMELA ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:STICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAIN ST
Mailing Address - Street 2:202
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4525
Mailing Address - Country:US
Mailing Address - Phone:508-650-9770
Mailing Address - Fax:
Practice Address - Street 1:20 MAIN ST
Practice Address - Street 2:202
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4525
Practice Address - Country:US
Practice Address - Phone:508-650-9770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health