Provider Demographics
NPI:1750304705
Name:MOLDAUER, PAMELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:MOLDAUER
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 1:30131 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-495-3666
Mailing Address - Fax:949-495-8194
Practice Address - Street 1:30131 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 235
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-495-3666
Practice Address - Fax:949-495-8194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4714104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW4714Medicare ID - Type Unspecified