Provider Demographics
NPI:1811958598
Name:BASS, PAMELA A (MSW LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:BASS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q STREET
Mailing Address - Street 2:SUITE 230
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137
Mailing Address - Country:US
Mailing Address - Phone:402-960-1652
Mailing Address - Fax:402-597-2349
Practice Address - Street 1:11330 Q STREET
Practice Address - Street 2:SUITE 230
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137
Practice Address - Country:US
Practice Address - Phone:402-960-1652
Practice Address - Fax:402-597-2349
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE683104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025349100Medicaid