Provider Demographics
NPI:1609909696
Name:FADAKAR, PAMELA (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:FADAKAR
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 1:8 KEYSTONE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-677-0817
Mailing Address - Fax:
Practice Address - Street 1:1007 FARMINGTON AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107
Practice Address - Country:US
Practice Address - Phone:860-586-8167
Practice Address - Fax:860-586-8192
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist