Provider Demographics
NPI:1538405550
Name:OBERRY, PAMELA SUSAN (LMSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUSAN
Last Name:OBERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30685 BARRINGTON ST
Mailing Address - Street 2:STE. 140
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5111
Mailing Address - Country:US
Mailing Address - Phone:248-414-4080
Mailing Address - Fax:248-414-4085
Practice Address - Street 1:30685 BARRINGTON ST
Practice Address - Street 2:STE. 140
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5111
Practice Address - Country:US
Practice Address - Phone:248-414-4080
Practice Address - Fax:248-414-4085
Is Sole Proprietor?:No
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical