Provider Demographics
NPI:1598745580
Name:PIMENTEL, PAULA R (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:PIMENTEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FRANKSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4231
Mailing Address - Country:US
Mailing Address - Phone:814-943-2503
Mailing Address - Fax:814-940-7244
Practice Address - Street 1:304 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4231
Practice Address - Country:US
Practice Address - Phone:814-943-2503
Practice Address - Fax:814-940-7244
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW009455L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA875003Medicare ID - Type Unspecified