Provider Demographics
NPI:1851418636
Name:WELLS, PAMELA LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNNE
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GILMAN FALLS AVE
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1311
Mailing Address - Country:US
Mailing Address - Phone:207-827-1942
Mailing Address - Fax:
Practice Address - Street 1:1066 KENDUSKEAG AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2914
Practice Address - Country:US
Practice Address - Phone:207-941-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC42661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical