Provider Demographics
NPI:1861931396
Name:HSU, PAMELA L (LISW-S)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:L
Last Name:HSU
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1587 E 31ST ST
Mailing Address - Street 2:#205
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-4366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8500 STATION ST STE 102
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4968
Practice Address - Country:US
Practice Address - Phone:216-245-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.18007971041C0700X
OHS.15023171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical