Provider Demographics
NPI:1558313437
Name:STANTON, PAMELA (MA MSW LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:STANTON
Suffix:
Gender:F
Credentials:MA MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ROOSEVELT AVENUE
Mailing Address - Street 2:SUITE 205 GATWAY HEALTHCARE INC
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860
Mailing Address - Country:US
Mailing Address - Phone:401-724-8400
Mailing Address - Fax:401-365-1100
Practice Address - Street 1:160 BEACHWOOD AVE
Practice Address - Street 2:
Practice Address - City:PAWPUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860
Practice Address - Country:US
Practice Address - Phone:401-722-5573
Practice Address - Fax:401-726-5571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW00934104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPS54564Medicaid