Provider Demographics
NPI:1447429659
Name:GOLDSMITH, PAMELA SUSAN (MA)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUSAN
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 MAITLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6862
Mailing Address - Country:US
Mailing Address - Phone:407-975-0400
Mailing Address - Fax:407-696-4831
Practice Address - Street 1:650 MAITLAND AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-6862
Practice Address - Country:US
Practice Address - Phone:407-975-0400
Practice Address - Fax:407-696-4831
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7419101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional