Provider Demographics
NPI:1891847422
Name:HENDERSON, PAMELA ALEXANDRA
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ALEXANDRA
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAM
Other - Middle Name:ALEXANDRA
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2001 THE ALAMEDA
Mailing Address - Street 2:ALLIANCE FOR COMMUNITY CARE
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1136
Mailing Address - Country:US
Mailing Address - Phone:408-261-7777
Mailing Address - Fax:408-254-9960
Practice Address - Street 1:2001 THE ALAMEDA
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SRVC TEAM ADULT OUTPATIENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1136
Practice Address - Country:US
Practice Address - Phone:408-261-7777
Practice Address - Fax:408-254-9960
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator