Provider Demographics
NPI:1467558148
Name:GODBOIS, PAMELA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:GODBOIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:RODERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:22 GREELEY ST
Mailing Address - Street 2:STE 5
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-4434
Mailing Address - Country:US
Mailing Address - Phone:603-672-5005
Mailing Address - Fax:603-672-6501
Practice Address - Street 1:16 ELM ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:NH
Practice Address - Zip Code:03055-4890
Practice Address - Country:US
Practice Address - Phone:603-672-5005
Practice Address - Fax:603-672-6501
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706660Y0NH01OtherBLUE CROSS
NH7706660Y0NH01OtherBLUE CROSS