Provider Demographics
NPI:1144950932
Name:TAYLOR, PAMELA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 BRIDGEWAY STE 241
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-3801
Mailing Address - Country:US
Mailing Address - Phone:415-786-5796
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY STE 241
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-3801
Practice Address - Country:US
Practice Address - Phone:415-786-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW22589OtherMENTAL HEALTH PROVIDER
CALCSW22589OtherBOARD OF BEHAVIORAL SCIENCES