Provider Demographics
NPI:1922551894
Name:RUSSO, PAMELA J (LSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:RUSSO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 LOWELL DR
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-9559
Mailing Address - Country:US
Mailing Address - Phone:610-207-2180
Mailing Address - Fax:484-664-7794
Practice Address - Street 1:900 S WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4179
Practice Address - Country:US
Practice Address - Phone:610-435-1541
Practice Address - Fax:484-664-7794
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133734104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker