Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 44SC05339100 | NJ |
N | 1041C0700X | Clinical Social Worker | R042224-1 | NY |
NPI | 1174656409 |
---|---|
Provider Name | Ms. Pamela J Pater-Ennis |
First Address | Bergenfield, NJ 07621-4504 |
Second Address | Bergenfield, NJ 07621-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 18/12/2019 |