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General NPI Number Information
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NPI Number | 1558859637
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Entity Type | Organization
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Legal Business Name | PAMELA D SIEMON LCSW LLC
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 51 DEPOT ST STE 207
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City | WATERTOWN
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State | CT
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Zip | 06795-2667
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Country | US
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Telephone | 860-806-2653
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Fax |
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Provider Business Mailing Address
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Address Line | 200 QUASSUK RD
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City | WOODBURY
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State | CT
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Zip | 06798-2013
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Country | US
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Telephone | 203-232-8009
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | PAMELA D SIEMON
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Credential | LCSW
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Telephone | 203-232-8009
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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 | 009745
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License Number State | CT
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