Healthcare Provider Details

I. General information

NPI: 1831478999
Provider Name (Legal Business Name): PAMELA JEAN TIBBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2011
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3295 FOREST INN RD SUITE 3
PALMERTON PA
18071
US

IV. Provider business mailing address

3295 FOREST INN RD SUITE 3
PALMERTON PA
18071
US

V. Phone/Fax

Practice location:
  • Phone: 855-826-8482
  • Fax: 855-826-8482
Mailing address:
  • Phone: 855-826-8482
  • Fax: 855-826-8482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW08143
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: