Provider Demographics
NPI:1841257755
Name:ROMAN, PAMELA R (PHD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:R
Last Name:ROMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:R
Other - Last Name:JOFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1400 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4192
Mailing Address - Country:US
Mailing Address - Phone:541-484-4971
Mailing Address - Fax:541-431-6450
Practice Address - Street 1:1400 HIGH ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4192
Practice Address - Country:US
Practice Address - Phone:541-484-4971
Practice Address - Fax:541-431-6450
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ286201OtherPACIFIC SOURCE
OR12517Medicare UPIN
ORJ286201OtherPACIFIC SOURCE