| Doctor Name: | MS. PAMELA SUZANNE GENGO |
| NPI Number: | 1083710594 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 11303 |
| Business Practice Address: | 1330 W Ramsey St Ste 100 Banning Mental Health Clinic Banning, CA - 922204448 |
| Business Phone Number: | 9518497142 |
| Business Fax Number: | |
| Mailing Address: | Banning Mental Health Clinic, P.o. Box 1148 BANNING |
| State: | CA |
| Postal Code: | 922204448 |
| Phone Number: | 9518497142 |
| Fax Number: | |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 07/16/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 11303 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |