Provider Demographics
NPI:1619152089
Name:HARDER, PAMELA A
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:HARDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1312
Mailing Address - Country:US
Mailing Address - Phone:559-592-7317
Mailing Address - Fax:559-594-4631
Practice Address - Street 1:1014 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1312
Practice Address - Country:US
Practice Address - Phone:559-592-7317
Practice Address - Fax:559-594-4631
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA215591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical