Healthcare Provider Details

I. General information

NPI: 1548582331
Provider Name (Legal Business Name): PAMELA AMELIA EVANS MSW-LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 SOLAR CIR
BALTIMORE MD
21234-6818
US

IV. Provider business mailing address

67 SOLAR CIR
BALTIMORE MD
21234-6818
US

V. Phone/Fax

Practice location:
  • Phone: 410-850-1345
  • Fax:
Mailing address:
  • Phone: 410-850-1345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07201
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: