Pamela Yvette Willis, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

09716 Issued in MD

Practice address

5310 Old Court Rd
Ste. 308
Randallstown, MD 21133-5243

Phone

(443) 804-3707

Fax

(410) 521-1944

NPI assigned

May 25, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265068800000",
    "number": "1750337721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3930 NEMO RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334041",
            "telephone_number": "443-804-3707",
            "fax_number": "410-521-1944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5310 OLD COURT RD",
            "address_2": "STE. 308",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335243",
            "telephone_number": "443-804-3707",
            "fax_number": "410-521-1944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "PAMELA",
        "middle_name": "YVETTE",
        "name_prefix": "Mrs.",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2010-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "09716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404403700",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Williams-Whitehead
• Keyanna D Williams
• Khalilah Williams
• Robert Williams
• Tiffany Samantha Williams, RN
• Mary Beth Winkeljohn, MS, CRNP-F
• Brandon J Woolford, PA
• Kenneth Wright, DHH
• Stella Wu
• Yuan-Haw Andrew Wu, MD

• Clinical Social Worker in Randallstown, MD
• Providers in Randallstown, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.