Provider Demographics
NPI:1790142263
Name:BAUGHMAN, PAMELA (BS)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAP
Mailing Address - Street 1:1615 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32922-6507
Mailing Address - Country:US
Mailing Address - Phone:321-305-6268
Mailing Address - Fax:
Practice Address - Street 1:1615 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-6507
Practice Address - Country:US
Practice Address - Phone:321-305-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health