Provider Demographics
NPI:1992823132
Name:KOSSEFF, PAMELA (MSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:KOSSEFF
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 POWEL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2676
Mailing Address - Country:US
Mailing Address - Phone:401-847-1723
Mailing Address - Fax:401-846-9868
Practice Address - Street 1:37 POWEL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2676
Practice Address - Country:US
Practice Address - Phone:401-847-1723
Practice Address - Fax:401-846-9868
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW006011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000009437-001OtherBLUE CROSS