Provider Demographics
NPI:1780627679
Name:LAND, PAMELA M (LISW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:LAND
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6449 WILSON MILLS RD.
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3438
Mailing Address - Country:US
Mailing Address - Phone:440-442-8800
Mailing Address - Fax:440-442-8804
Practice Address - Street 1:6449 WILSON MILLS RD.
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-442-8800
Practice Address - Fax:440-442-8804
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 00017561041C0700X
OHI.00017561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical