Healthcare Provider Details

I. General information

NPI: 1831151570
Provider Name (Legal Business Name): PAMELA G PARKER LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 BEECHMONT AVE. #303
CINCINNATI OH
45255
US

IV. Provider business mailing address

8595 BEECHMONT AVE. #303
CINCINNATI OH
45255
US

V. Phone/Fax

Practice location:
  • Phone: 513-520-3365
  • Fax: 513-734-0065
Mailing address:
  • Phone: 513-520-3365
  • Fax: 513-734-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberF0007575
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberI0007575
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0007575
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: