Provider Demographics
NPI:1447606892
Name:CASACUBERTA, PAMELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:CASACUBERTA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:ALBRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17209 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3492
Mailing Address - Country:US
Mailing Address - Phone:323-428-5873
Mailing Address - Fax:
Practice Address - Street 1:17209 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3492
Practice Address - Country:US
Practice Address - Phone:323-428-5873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical