Provider Demographics
NPI:1760549802
Name:BARBACK, PAMELA E (MSPD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:E
Last Name:BARBACK
Suffix:
Gender:F
Credentials:MSPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17520 WEXFORD TER
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2872
Mailing Address - Country:US
Mailing Address - Phone:718-297-6517
Mailing Address - Fax:
Practice Address - Street 1:17520 WEXFORD TER
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2872
Practice Address - Country:US
Practice Address - Phone:718-297-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003549101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health