Provider Demographics
NPI:1366608358
Name:STRAKER, PAMELA D
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:D
Last Name:STRAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 MONTAGUE ST STE 118
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3548
Mailing Address - Country:US
Mailing Address - Phone:917-693-6263
Mailing Address - Fax:718-253-0850
Practice Address - Street 1:137 MONTAGUE ST STE 118
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3548
Practice Address - Country:US
Practice Address - Phone:917-693-6263
Practice Address - Fax:718-253-0850
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical