Provider Demographics
NPI:1255430377
Name:STAFFIER, PAMELA M (CHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:STAFFIER
Suffix:
Gender:F
Credentials:CHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:68 ADAMS ST
Mailing Address - City:WESTBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-366-0406
Mailing Address - Fax:508-366-6221
Practice Address - Street 1:57 E MAIN ST
Practice Address - Street 2:SUITE #200
Practice Address - City:WESTBORO
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-366-0406
Practice Address - Fax:508-366-6221
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1467103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
W01331Medicare ID - Type Unspecified