Provider Demographics
NPI:1255360681
Name:RANDS, PAMELA KAY (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:KAY
Last Name:RANDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 VALLEY GREEN DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1722
Mailing Address - Country:US
Mailing Address - Phone:585-388-5969
Mailing Address - Fax:585-247-2120
Practice Address - Street 1:1 SAREDON PL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-4070
Practice Address - Country:US
Practice Address - Phone:585-234-6855
Practice Address - Fax:585-247-2120
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0401131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7972340OtherAETNA
NY107788FKOtherPREFERRED CARE