Provider Demographics
NPI:1295893600
Name:RADEMACHER, PAMELA N (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:N
Last Name:RADEMACHER
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 1:17 GREELY SQUARE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1516
Mailing Address - Country:US
Mailing Address - Phone:516-676-8692
Mailing Address - Fax:
Practice Address - Street 1:17 GREELY SQUARE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1516
Practice Address - Country:US
Practice Address - Phone:516-676-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05155711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07538OtherMC GHI
NYN343T2OtherBC BS
NYNB9952Medicare ID - Type UnspecifiedNASSAU CO