Healthcare Provider Details

I. General information

NPI: 1073001517
Provider Name (Legal Business Name): PAMELA MASSEY LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 09/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

IV. Provider business mailing address

680 NORTHLAND BLVD
CINCINNATI OH
45240-3248
US

V. Phone/Fax

Practice location:
  • Phone: 513-941-4999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1904026
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: