Provider Demographics
NPI:1881762631
Name:DAISEY, PAMELA ANN (LPCMH)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANN
Last Name:DAISEY
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12649 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:ELLENDALE
Mailing Address - State:DE
Mailing Address - Zip Code:19941-3307
Mailing Address - Country:US
Mailing Address - Phone:302-422-1530
Mailing Address - Fax:302-422-2320
Practice Address - Street 1:12649 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:DE
Practice Address - Zip Code:19941-3307
Practice Address - Country:US
Practice Address - Phone:302-422-1530
Practice Address - Fax:302-422-2320
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000250101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE050373LPCOtherBCBS
DE10000022578Medicaid
DE100022580Medicaid