Provider Demographics
NPI:1568604288
Name:SKORSTAD, PAMELA N (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:N
Last Name:SKORSTAD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1644 VIA TULIPAN
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3723
Mailing Address - Country:US
Mailing Address - Phone:949-310-6172
Mailing Address - Fax:949-276-8190
Practice Address - Street 1:647 CAMINO DE LOS MARES STE 226
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2860
Practice Address - Country:US
Practice Address - Phone:949-310-6172
Practice Address - Fax:949-276-8190
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19619103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist