Healthcare Provider Details

I. General information

NPI: 1194175802
Provider Name (Legal Business Name): PAMELA MACFARLANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 JOHNNY CAKE HILL RD
MIDDLETOWN RI
02842-5674
US

IV. Provider business mailing address

111 LAWRENCE ST APARTMENT A
MIDDLETOWN RI
02842-4898
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-1213
  • Fax: 401-324-6251
Mailing address:
  • Phone: 401-848-6383
  • Fax: 401-324-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCDP00574
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: