Provider Demographics
NPI:1912923947
Name:WALTER, PAMELA ANN (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:WALTER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:ALBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 BURNLEY RISE
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4517
Mailing Address - Country:US
Mailing Address - Phone:585-248-8173
Mailing Address - Fax:585-264-1367
Practice Address - Street 1:768 CROSS KEYS OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3512
Practice Address - Country:US
Practice Address - Phone:585-425-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02192311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
10164BMedicare ID - Type Unspecified