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General NPI Number Information
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NPI Number | 1205066685
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Entity Type | Individual
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Provider Name | PAMELA TOMKO MSW,LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 264 S LEHIGH AVE
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City | FRACKVILLE
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State | PA
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Zip | 17931-2205
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Country | US
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Telephone | 570-874-2643
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Fax |
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Provider Business Mailing Address
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Address Line | 199 TROUT LN
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City | ZION GROVE
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State | PA
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Zip | 17985-9590
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Country | US
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Telephone | 570-590-0506
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW017331
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License Number State | PA
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