=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649363219
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELLA JOAN CHAIRS NORBECK LCSW C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3525 RESOURCE DRIVE ROOM C 47
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-655-7655
-----------------------------------------------------
Fax | 410-655-3941
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10400 RIDGELAND ROAD STE 1
-----------------------------------------------------
City | COCKEYSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-628-6120
-----------------------------------------------------
Fax | 410-628-9825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 04396
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------