1336120617 NPI number — MISS PAMELA GRACE PEROS LCSW, QCSW

Table of content: MISS PAMELA GRACE PEROS LCSW, QCSW (NPI 1336120617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336120617 NPI number — MISS PAMELA GRACE PEROS LCSW, QCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEROS
Provider First Name:
PAMELA
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW, QCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336120617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 JARRETT WHITE RD
Provider Second Line Business Mailing Address:
TRIPLER ARMY MEDICAL CENTER ATTN: MCHK-QS
Provider Business Mailing Address City Name:
TRIPLER AMC
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96859-5001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-433-2460
Provider Business Mailing Address Fax Number:
808-433-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S. ARMY HEALTH CLINIC - SCHOFIELD BARRACKS
Provider Second Line Business Practice Location Address:
BUILDING #681 - 2ND FLOOR
Provider Business Practice Location Address City Name:
SCHOFIELD BARRACKS
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-8565
Provider Business Practice Location Address Fax Number:
808-433-8551
Provider Enumeration Date:
11/14/2005

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: 1041C0700X , with the licence number:  3215 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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