Provider Demographics
NPI:1578792586
Name:MATHEWS, PAMELA NASH (MSW, LISW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:NASH
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:MSW, LISW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CALLE DON JOSE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2391
Mailing Address - Country:US
Mailing Address - Phone:505-995-1983
Mailing Address - Fax:505-995-1983
Practice Address - Street 1:127 EASTGATE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3300
Practice Address - Country:US
Practice Address - Phone:505-920-0460
Practice Address - Fax:505-995-1983
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2009-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-4117 LISW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM11984123OtherCAQH
NMIN PROCESSMedicaid