Provider Demographics
NPI:1932282985
Name:HERRINGSHAW, PAMELA MARGARET (PHD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARGARET
Last Name:HERRINGSHAW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 FLORENCE CT
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1758
Mailing Address - Country:US
Mailing Address - Phone:248-684-2676
Mailing Address - Fax:
Practice Address - Street 1:1800 N MILFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1047
Practice Address - Country:US
Practice Address - Phone:248-684-6400
Practice Address - Fax:248-684-5973
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005506103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF34993022Medicare ID - Type Unspecified