Provider Demographics
NPI:1205163193
Name:LAVERGNE, PAMELA PHYLLIS (LICSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:PHYLLIS
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905A HEWITT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3821
Mailing Address - Country:US
Mailing Address - Phone:425-626-1620
Mailing Address - Fax:
Practice Address - Street 1:2905A HEWITT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3821
Practice Address - Country:US
Practice Address - Phone:425-626-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608381191041C0700X
WARC00054513101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health