Provider Demographics
NPI:1477036325
Name:HUBBARD, PAMELA ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BRIDGECOURT LN
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3055
Mailing Address - Country:US
Mailing Address - Phone:617-686-6783
Mailing Address - Fax:
Practice Address - Street 1:9 POND LN STE 4B
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2862
Practice Address - Country:US
Practice Address - Phone:617-686-6783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10222721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical