Healthcare Provider Details

I. General information

NPI: 1174436471
Provider Name (Legal Business Name): PAMELA LYNNETTE SMITH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S BURROWES ST STE 604
STATE COLLEGE PA
16801-3864
US

IV. Provider business mailing address

700 MASSACHUSETTS AVE FL 3
CAMBRIDGE MA
02139-3345
US

V. Phone/Fax

Practice location:
  • Phone: 888-500-2067
  • Fax: 617-649-8520
Mailing address:
  • Phone: 888-500-2067
  • Fax: 617-649-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001904
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: