Provider Demographics
NPI:1891156832
Name:LOPARDO, PAMELA SUSAN (LCSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUSAN
Last Name:LOPARDO
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 1:1118 F ST
Mailing Address - Street 2:PO BOX B
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1930
Mailing Address - Country:US
Mailing Address - Phone:208-799-4440
Mailing Address - Fax:208-799-5171
Practice Address - Street 1:1118 F ST
Practice Address - Street 2:PO BOX B
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1930
Practice Address - Country:US
Practice Address - Phone:208-799-4440
Practice Address - Fax:208-799-5171
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-338511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical