Provider Demographics
NPI:1447996921
Name:SIMON, PAMELA RENEE (LICSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:SIMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:R
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:7918 53RD AVE W
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-7977
Mailing Address - Country:US
Mailing Address - Phone:253-370-5154
Mailing Address - Fax:
Practice Address - Street 1:7801 53RD AVE W
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-7974
Practice Address - Country:US
Practice Address - Phone:253-370-5154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60074500104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty