MEDICARE: PAMELA JEAN CONNIE 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	86689	CA
2	251S00000X	Community/Behavioral Health Agency	86689	CA

General Provider Information

NPI Number	:	1821841552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA JEAN CONNIE LCSW

Provider Business Mailing Address
First Line	:	14 VETERAN WAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2227
Country	:	US
Telephone Number	:	510-917-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 VETERAN WAY
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94602-2227
Country	:	US
Telephone Number	:	510-917-8358
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	04/12/2024

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