Provider Demographics
NPI:1255598967
Name:HARGRAVES, PAMELA JANICE (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JANICE
Last Name:HARGRAVES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 FILLMORE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3496
Mailing Address - Country:US
Mailing Address - Phone:415-922-7773
Mailing Address - Fax:415-567-3297
Practice Address - Street 1:3109 FILLMORE ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3496
Practice Address - Country:US
Practice Address - Phone:415-922-7773
Practice Address - Fax:415-567-3297
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist