Provider Demographics
NPI:1679650162
Name:DEAN, PAMELA CAROL (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:CAROL
Last Name:DEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1598
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85242-1598
Mailing Address - Country:US
Mailing Address - Phone:480-258-2915
Mailing Address - Fax:480-888-0231
Practice Address - Street 1:6021 S KINGS RANCH RD
Practice Address - Street 2:6D
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85218-4774
Practice Address - Country:US
Practice Address - Phone:480-258-2915
Practice Address - Fax:480-888-0231
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-28541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ752586Medicaid