Provider Demographics
NPI:1295951945
Name:SLATER, PAMELA MAUREEN (PHD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MAUREEN
Last Name:SLATER
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 1:17 FARM RD # 1
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-6600
Mailing Address - Country:US
Mailing Address - Phone:781-239-1511
Mailing Address - Fax:
Practice Address - Street 1:17 FARM RD # 1
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-6600
Practice Address - Country:US
Practice Address - Phone:781-239-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3042103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist