Provider Demographics
NPI:1174162788
Name:SANDERS, PAMELA LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LYNN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3049
Mailing Address - Country:US
Mailing Address - Phone:607-753-0234
Mailing Address - Fax:
Practice Address - Street 1:165 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3049
Practice Address - Country:US
Practice Address - Phone:607-753-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0983941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical