Provider Demographics
NPI:1861080061
Name:STANLEY BOOZE, PAMELA (LICSW, LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:STANLEY BOOZE
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:STANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW, LCSW-C
Mailing Address - Street 1:2288 BRIMSTONE PL
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1870
Mailing Address - Country:US
Mailing Address - Phone:443-468-7705
Mailing Address - Fax:
Practice Address - Street 1:2288 BRIMSTONE PL
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1870
Practice Address - Country:US
Practice Address - Phone:443-468-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD159031041C0700X
DCLC500802991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical