Provider Demographics
NPI:1669456521
Name:MASTERS, PAMELA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:DENISE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:DENISE
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 BRULE ST
Mailing Address - Street 2:
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-6100
Mailing Address - Country:US
Mailing Address - Phone:502-626-9855
Mailing Address - Fax:502-626-6140
Practice Address - Street 1:93 MASTERS DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8660
Practice Address - Country:US
Practice Address - Phone:270-317-3102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical