Healthcare Provider Details

I. General information

NPI: 1114430386
Provider Name (Legal Business Name): PAMELA LEE GATES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W CREST ST STE 102
ESCONDIDO CA
92025
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4930
  • Fax: 760-489-4933
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: