Provider Demographics
NPI:1639348865
Name:CLARKE, PAMELA ORREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ORREN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:ORREN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 22772
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-5372
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical