Provider Demographics
NPI:1821348871
Name:SIEMON, PAMELA D (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:SIEMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:D
Other - Last Name:SIEMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:200 QUASSUK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-2013
Mailing Address - Country:US
Mailing Address - Phone:203-263-2821
Mailing Address - Fax:
Practice Address - Street 1:51 DEPOT ST STE 207
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795
Practice Address - Country:US
Practice Address - Phone:203-232-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0859291041C0700X
CT0097451041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker