Provider Demographics
NPI:1841706637
Name:PAMMER, ANDREA (MA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:PAMMER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SHAVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1036
Mailing Address - Country:US
Mailing Address - Phone:304-365-2974
Mailing Address - Fax:
Practice Address - Street 1:1314 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1436
Practice Address - Country:US
Practice Address - Phone:304-996-2658
Practice Address - Fax:304-367-0233
Is Sole Proprietor?:No
Enumeration Date:2017-12-16
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV984103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical