1043242464 NPI number — DR. PAMELA ANN ESCOBAR PHD, LMHC

Table of content: DR. PAMELA ANN ESCOBAR PHD, LMHC (NPI 1043242464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043242464 NPI number — DR. PAMELA ANN ESCOBAR PHD, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESCOBAR
Provider First Name:
PAMELA
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESCOBAR
Provider Other First Name:
PAMELA
Provider Other Middle Name:
FARR
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1043242464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37743 BOUGAINVILLEA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DADE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33525-4737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-467-0444
Provider Business Mailing Address Fax Number:
352-567-9513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4353 GALL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ZEPHYRHILLS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33542-6207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-467-0444
Provider Business Practice Location Address Fax Number:
352-567-9513
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  MH7563 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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