Provider Demographics
NPI:1831242296
Name:SMITH, PAMELA RUTH (MSW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:RUTH
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N 16TH ST APT 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4450
Mailing Address - Country:US
Mailing Address - Phone:225-953-1923
Mailing Address - Fax:
Practice Address - Street 1:4700 N 16TH ST APT 120
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4450
Practice Address - Country:US
Practice Address - Phone:225-953-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040157851041C0700X
TX1076641041C0700X
AZLCSW23531041C0700X
LA111441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ749814OtherAHCCCS PROVIDER ID