Provider Demographics
NPI:1013174952
Name:DELLO, PAMELA MCGRATH (MFT)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MCGRATH
Last Name:DELLO
Suffix:
Gender:F
Credentials:MFT
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 1012
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-1012
Mailing Address - Country:US
Mailing Address - Phone:760-480-2255
Mailing Address - Fax:760-741-6645
Practice Address - Street 1:474 W VERMONT AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6584
Practice Address - Country:US
Practice Address - Phone:760-480-2255
Practice Address - Fax:760-741-6645
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 30433106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist