Provider Demographics
NPI:1639343031
Name:MANN, PAMELA (MSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:MANN
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:PITA
Other - Middle Name:
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:776 S STATE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5847
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:
Practice Address - Street 1:776 S STATE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5847
Practice Address - Country:US
Practice Address - Phone:707-463-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA21653OtherBBS