Provider Demographics
NPI:1588846778
Name:SPERLING, PAMELA GAIL (MA, EDM, LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GAIL
Last Name:SPERLING
Suffix:
Gender:F
Credentials:MA, EDM, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7734
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06836-7734
Mailing Address - Country:US
Mailing Address - Phone:203-892-5867
Mailing Address - Fax:203-769-1715
Practice Address - Street 1:132 E PUTNAM AVE
Practice Address - Street 2:2 EAST
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2744
Practice Address - Country:US
Practice Address - Phone:203-892-5867
Practice Address - Fax:203-769-1715
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002121101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809618OtherAHCCCS