Provider Demographics
NPI:1770891517
Name:WITMAN, PAMELA JANE (MED, LCSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JANE
Last Name:WITMAN
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:JANE
Other - Last Name:WITMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED,LCSW
Mailing Address - Street 1:1288 DOE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9236
Mailing Address - Country:US
Mailing Address - Phone:570-640-2556
Mailing Address - Fax:
Practice Address - Street 1:340 S LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-2127
Practice Address - Country:US
Practice Address - Phone:570-366-5096
Practice Address - Fax:570-366-8755
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0173631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical