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General NPI Number Information
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NPI Number | 1023701315
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Entity Type | Individual
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Provider Name | PAMELA WASNICK
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Gender | Female
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Dates
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Enumeration Date | 06/01/2023
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Last Update Date | 01/06/2026
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Provider Practice Location Address
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Address Line | 26845 POINT LOOKOUT RD
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City | LEONARDTOWN
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State | MD
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Zip | 20650-4935
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Country | US
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Telephone | 240-309-4015
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Fax |
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Provider Business Mailing Address
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Address Line | 654 RAILROAD ST
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City | SOUTH FORK
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State | PA
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Zip | 15956-1253
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Country | US
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Telephone | 814-659-4745
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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