Provider Demographics
NPI:1528598588
Name:VALENTINE, PAMELA V (MD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:V
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 AVONDALE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8453
Mailing Address - Country:US
Mailing Address - Phone:850-590-8190
Mailing Address - Fax:
Practice Address - Street 1:2940 E PARK AVE STE 1-A
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-3446
Practice Address - Country:US
Practice Address - Phone:850-590-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW144811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical