Provider Demographics
NPI:1831151570
Name:PARKER, PAMELA G (LISW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:PARKER
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 1:8595 BEECHMONT AVE. #303
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255
Mailing Address - Country:US
Mailing Address - Phone:513-520-3365
Mailing Address - Fax:513-734-0065
Practice Address - Street 1:8595 BEECHMONT AVE. #303
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255
Practice Address - Country:US
Practice Address - Phone:513-520-3365
Practice Address - Fax:513-734-0065
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF00075752084P0802X
OHI0007575104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW26241Medicare PIN
OHPASW26243Medicare PIN
OHPASW26241Medicare PIN
OHSW26242Medicare PIN
PASW26241Medicare PIN