Provider Demographics
NPI:1053985655
Name:SURRENCY, PAMELA DENISE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:SURRENCY
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 1:2037 UTICA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3234
Mailing Address - Country:US
Mailing Address - Phone:718-253-1366
Mailing Address - Fax:718-758-5883
Practice Address - Street 1:2037 UTICA AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3234
Practice Address - Country:US
Practice Address - Phone:718-253-1366
Practice Address - Fax:718-758-5683
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor