Healthcare Provider Details

I. General information

NPI: 1922013358
Provider Name (Legal Business Name): ALVIN PAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/24/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MCKINLEY AVE APARTMENT CG-1
WHITE PLAINS NY
10606-1635
US

IV. Provider business mailing address

65 MCKINLEY AVE APARTMENT CG-1
WHITE PLAINS NY
10606-1635
US

V. Phone/Fax

Practice location:
  • Phone: 712-829-0652
  • Fax: 914-437-7139
Mailing address:
  • Phone: 712-829-0652
  • Fax: 914-437-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3893
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number3893
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number3893
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number003893-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: