Provider Demographics
NPI:1922013358
Name:PAM, ALVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:PAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MCKINLEY AVE
Mailing Address - Street 2:APARTMENT CG-1
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1635
Mailing Address - Country:US
Mailing Address - Phone:914-428-1830
Mailing Address - Fax:
Practice Address - Street 1:2105 WILLIAMSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1601
Practice Address - Country:US
Practice Address - Phone:718-829-0652
Practice Address - Fax:718-518-7647
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3893103TC0700X, 103TF0000X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy