Provider Demographics
NPI:1982678926
Name:MCCLOSKEY, PAMELA G (M ED)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:G
Last Name:MCCLOSKEY
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8988
Mailing Address - Street 2:205 MILL ST
Mailing Address - City:MILESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16853
Mailing Address - Country:US
Mailing Address - Phone:814-357-2400
Mailing Address - Fax:814-357-7740
Practice Address - Street 1:205 MILL ST
Practice Address - Street 2:
Practice Address - City:MILESBURG
Practice Address - State:PA
Practice Address - Zip Code:16853
Practice Address - Country:US
Practice Address - Phone:814-357-2400
Practice Address - Fax:814-357-7740
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004699L103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018001520002Medicaid