Provider Demographics
NPI:1801973136
Name:PAMELA M. TAYLOR, PSY.D. LLC
Entity type:Organization
Organization Name:PAMELA M. TAYLOR, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:860-687-1085
Mailing Address - Street 1:44 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2909
Mailing Address - Country:US
Mailing Address - Phone:860-687-1085
Mailing Address - Fax:860-687-1907
Practice Address - Street 1:44 COURT ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2909
Practice Address - Country:US
Practice Address - Phone:860-687-1085
Practice Address - Fax:860-687-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherSOLE PROPRIETOR