Provider Demographics
NPI:1649217993
Name:PASTERNACK, MICHELLE RENEE (CCSW C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:PASTERNACK
Suffix:
Gender:F
Credentials:CCSW C
Other - Prefix:
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Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-823-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:7130 MINSTREL WAY
Practice Address - Street 2:SUITE 212
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-290-6940
Practice Address - Fax:410-290-9763
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD048512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
150NOtherMBMD GROUP
52317109OtherBSMD INDIVIDUAL
PVPB119420OtherAPS INDIVIDUAL
002668OtherVAL INDIVIDUAL
253552OtherCOMP INDIVIDUAL
360218OtherMHN GROUP
705BPSOtherBSMD GROUP
K452OtherBSDC GROUP
226570OtherKAIS INDIVIDUAL
150N124GOtherMBMD INDIVIDUAL
226570OtherKAIS GROUP
002668OtherVAL GROUP
2139989OtherMAMS INDIVIDUAL
0016OtherBSDC INDIVIDUAL
252450OtherCOMP GROUP
331947OtherMHN INDIVIDUAL
PVPB119420OtherAPS GROUP