Provider Demographics
NPI:1710116884
Name:WOLLET, PAMELA R (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:WOLLET
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 1:267 FLUMAN RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-8588
Mailing Address - Country:US
Mailing Address - Phone:570-220-6270
Mailing Address - Fax:570-505-1241
Practice Address - Street 1:1000 COMMERCE PARK DR STE 307
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5475
Practice Address - Country:US
Practice Address - Phone:570-220-6270
Practice Address - Fax:272-202-5097
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PASW127684104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007777400036Medicaid