Provider Demographics
NPI:1205066685
Name:TOMKO, PAMELA (MSW,LCSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:TOMKO
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 TROUT LN
Mailing Address - Street 2:
Mailing Address - City:ZION GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:17985-9590
Mailing Address - Country:US
Mailing Address - Phone:570-590-0506
Mailing Address - Fax:
Practice Address - Street 1:264 S LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:FRACKVILLE
Practice Address - State:PA
Practice Address - Zip Code:17931-2205
Practice Address - Country:US
Practice Address - Phone:570-874-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0173311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA124232320001Medicaid