MEDICARE: PAMELA MICHELE ADAMAITIS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149.014760	IL

General Provider Information

NPI Number	:	1770724171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MICHELE ADAMAITIS LCSW

Provider Business Mailing Address
First Line	:	103 N 11TH AVE
Second Line	:	SUITE 107
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2289
Country	:	US
Telephone Number	:	630-648-9146
Fax Number	:	888-255-9782

Provider Business Practice Location Address
First Line	:	103 N 11TH AVE
Second Line	:	SUITE 107
City	:	ST CHARLES
State	:	IL
Zip	:	60174-2289
Country	:	US
Telephone Number	:	630-648-9146
Fax Number	:	888-255-9782

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2009
Last Update Date	:	08/19/2013

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