Doctor Name: | PAMELA PETKANAS |
NPI Number: | 1225439144 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 079994-01 |
Business Practice Address: | 6 Marion Ave Cold Spring, NY - 105162925 |
Business Phone Number: | 9082308131 |
Business Fax Number: | |
Mailing Address: | 6 Marion Ave, COLD SPRING |
State: | NY |
Postal Code: | 105162925 |
Phone Number: | 9082308131 |
Fax Number: | |
NPI Enumeration Date: | 09/10/2014 |
NPI Last Update Date: | 09/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 079994-01 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |