Provider Demographics
NPI:1295771533
Name:DEVANEY, PAMELA GRACE (PSYD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:GRACE
Last Name:DEVANEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-2401
Mailing Address - Country:US
Mailing Address - Phone:978-373-0786
Mailing Address - Fax:978-373-0778
Practice Address - Street 1:63 PARK ST
Practice Address - Street 2:SUITE 15
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3662
Practice Address - Country:US
Practice Address - Phone:978-474-5004
Practice Address - Fax:978-474-5004
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7935103G00000X, 103T00000X, 103TA0700X, 103TC0700X, 103TC2200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0501221Medicaid
MAW06131OtherBLIE CROSS BLUE SHIELD
MAW06131OtherBLIE CROSS BLUE SHIELD
MA0501221Medicaid