Provider Demographics
NPI:1609970227
Name:MEYERSON, PAMELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:MEYERSON
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 1:900 N SKOKIE BLVD.
Mailing Address - Street 2:STE. 100
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4014
Mailing Address - Country:US
Mailing Address - Phone:847-579-0136
Mailing Address - Fax:
Practice Address - Street 1:900 N SKOKIE BLVD.
Practice Address - Street 2:STE. 100
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4014
Practice Address - Country:US
Practice Address - Phone:847-579-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490078031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205803Medicare ID - Type Unspecified