Provider Demographics
NPI:1770636730
Name:GEIB, PAMELA GAIL (EDD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GAIL
Last Name:GEIB
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1801
Mailing Address - Country:US
Mailing Address - Phone:617-332-2129
Mailing Address - Fax:
Practice Address - Street 1:7 BRIAR LN
Practice Address - Street 2:
Practice Address - City:NEWTONVILLE
Practice Address - State:MA
Practice Address - Zip Code:02460-1801
Practice Address - Country:US
Practice Address - Phone:617-332-2129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3095103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGE WO3197OtherBLUE CROSS BLUE SHIELD