Provider Demographics
NPI:1447554282
Name:FRED, PAMELA S (MS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:FRED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SW EXMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2526
Mailing Address - Country:US
Mailing Address - Phone:772-979-0302
Mailing Address - Fax:
Practice Address - Street 1:121 N 2ND ST
Practice Address - Street 2:SUITE 301
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4435
Practice Address - Country:US
Practice Address - Phone:772-595-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health