Provider Demographics
NPI:1134368905
Name:BRIGHAM, PAMELA ANNE (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANNE
Last Name:BRIGHAM
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-1644
Mailing Address - Country:US
Mailing Address - Phone:413-230-0420
Mailing Address - Fax:413-533-0003
Practice Address - Street 1:238 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1046
Practice Address - Country:US
Practice Address - Phone:413-529-9300
Practice Address - Fax:866-644-0870
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10258371041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1310224Medicaid
MA1310224Medicaid