Provider Demographics
NPI:1861770497
Name:PAMELA MCBRIDE LAND, LISW, LLC
Entity type:Organization
Organization Name:PAMELA MCBRIDE LAND, LISW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAND
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:440-289-6524
Mailing Address - Street 1:6449 WILSON MILLS RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3438
Mailing Address - Country:US
Mailing Address - Phone:440-442-8800
Mailing Address - Fax:440-442-8804
Practice Address - Street 1:6449 WILSON MILLS RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3438
Practice Address - Country:US
Practice Address - Phone:440-442-8800
Practice Address - Fax:440-442-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00017561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty