MEDICARE: PAMELA LOUISE THOMAS 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	R037551	NY

General Provider Information

NPI Number	:	1972716900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LOUISE THOMAS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1450
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11202-1450
Country	:	US
Telephone Number	:	718-783-0692
Fax Number	:	718-783-0692

Provider Business Practice Location Address
First Line	:	21 SAINT JAMES PL APT 3N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11205-5023
Country	:	US
Telephone Number	:	917-279-6197
Fax Number	:	718-783-0692

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	05/24/2009

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