Healthcare Provider Details

I. General information

NPI: 1831687391
Provider Name (Legal Business Name): PAMELA JEAN MURACO-SIMONS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 EMPIRE STATE BLVD
CASTLETON NY
12033-9751
US

IV. Provider business mailing address

7 BRINKER DR S
RENSSELAER NY
12144-9503
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-8771
  • Fax:
Mailing address:
  • Phone: 518-238-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number050396-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: