Provider Demographics
NPI:1679838262
Name:HODGE, PAMELA S
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:S
Last Name:HODGE
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 1:1748 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE D- 1
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-2122
Mailing Address - Country:US
Mailing Address - Phone:941-359-1927
Mailing Address - Fax:
Practice Address - Street 1:1748 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE D-1
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-2122
Practice Address - Country:US
Practice Address - Phone:941-359-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker