Provider Demographics
NPI:1821532854
Name:BERANEK, PAMELA (LSCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BERANEK
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:TINOCO-CARREON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSCSW
Mailing Address - Street 1:123 N TYLER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3726
Mailing Address - Country:US
Mailing Address - Phone:316-869-2230
Mailing Address - Fax:
Practice Address - Street 1:123 N TYLER RD STE 300
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3726
Practice Address - Country:US
Practice Address - Phone:316-869-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS052901041C0700X
KS10045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker