Provider Demographics
NPI:1336346873
Name:PIERCE, PAMELA JO (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:JO
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:JO
Other - Last Name:PIERCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:120 PLANT AVENUE
Mailing Address - Street 2:FREE, FAMILY WELLNESS CENTER,
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-851-3810
Mailing Address - Fax:631-273-4592
Practice Address - Street 1:1399 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-7400
Practice Address - Country:US
Practice Address - Phone:845-279-5908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1241103TC0700X
MO2004013227103TC0700X
NY020113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO499312601Medicaid