Individual
DR. PAMELA V PERCIVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2100 EAST GENESSEE STREET, SYRACUSE, NY 13214
(315) 475-2215
Mailing address
2100 EAST GENESSEE STREET, SYRACUSE, NY 13214
(315) 475-2215
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
007381
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00751217
—
NY
01
—
SO73811
WORKERS COMP
—
Enumeration date
10/31/2006
Last updated
07/08/2007
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