Provider Demographics
NPI:1710093703
Name:KIRST, PAMELA FREUNDL (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:FREUNDL
Last Name:KIRST
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 WILSHIRE BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2348
Mailing Address - Country:US
Mailing Address - Phone:310-208-1144
Mailing Address - Fax:
Practice Address - Street 1:3130 WILSHIRE BLVD STE 550
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2348
Practice Address - Country:US
Practice Address - Phone:310-208-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6577103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical