Provider Demographics
NPI:1790842458
Name:PAMELA W LINNELL PH D P C
Entity Type:Organization
Organization Name:PAMELA W LINNELL PH D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:W
Authorized Official - Last Name:LINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-622-4519
Mailing Address - Street 1:400 N PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE #1080
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4754
Mailing Address - Country:US
Mailing Address - Phone:505-622-4519
Mailing Address - Fax:
Practice Address - Street 1:400 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE #1080
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4754
Practice Address - Country:US
Practice Address - Phone:505-622-4519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM900521529Medicare PIN
NM900521529Medicare Oscar/Certification