Provider Demographics
NPI:1689639387
Name:GEORGE-KRAKOWSKI, PAMELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:GEORGE-KRAKOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:19A SOUTH VIEW ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570
Mailing Address - Country:US
Mailing Address - Phone:914-239-8491
Mailing Address - Fax:718-792-2496
Practice Address - Street 1:3594 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465
Practice Address - Country:US
Practice Address - Phone:718-792-4178
Practice Address - Fax:718-792-2496
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW141801PRO103T00000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7400757OtherGHI
N5561OtherMULTIPLAN
108009OtherMHN
141801OtherHIP
N55531OtherEMPIRE
14027818OtherANTHEM
135277OtherVALUE OPTIONS
P416071OtherOXFORD
14027818OtherANTHEM