Provider Demographics
NPI:1942715081
Name:DELORETTA, PAMELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DELORETTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:146 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-1964
Mailing Address - Country:US
Mailing Address - Phone:717-560-3782
Mailing Address - Fax:717-560-3787
Practice Address - Street 1:146 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1964
Practice Address - Country:US
Practice Address - Phone:717-560-3782
Practice Address - Fax:717-560-3787
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0197241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical