Provider Demographics
NPI:1013056829
Name:MYERS, PAMELA ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5580 BROADWAY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2380
Mailing Address - Country:US
Mailing Address - Phone:716-479-8590
Mailing Address - Fax:888-972-8216
Practice Address - Street 1:5580 BROADWAY ST STE 4
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2380
Practice Address - Country:US
Practice Address - Phone:716-479-8590
Practice Address - Fax:888-972-8216
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041693-12084P0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty