Provider Demographics
NPI:1396253688
Name:MALTZ, PAMELA FINEMAN (MSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:FINEMAN
Last Name:MALTZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:978 WORCESTER ST # 309
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-3709
Mailing Address - Country:US
Mailing Address - Phone:617-899-2035
Mailing Address - Fax:
Practice Address - Street 1:33 N COMMON ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4311
Practice Address - Country:US
Practice Address - Phone:781-593-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1004621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical