Provider Demographics
NPI:1184855280
Name:COURTNEY, PAMELA S (MA, LMHC)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01904-2915
Mailing Address - Country:US
Mailing Address - Phone:781-477-6930
Mailing Address - Fax:
Practice Address - Street 1:60 GRANITE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2915
Practice Address - Country:US
Practice Address - Phone:781-477-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9108101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health