Provider Demographics
NPI:1457559916
Name:PERNICK, PAMELA A (CASAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:PERNICK
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-2100
Mailing Address - Country:US
Mailing Address - Phone:716-681-4957
Mailing Address - Fax:716-681-4959
Practice Address - Street 1:11 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-2100
Practice Address - Country:US
Practice Address - Phone:716-681-4957
Practice Address - Fax:716-681-4959
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7311101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)