Basic Information
| Provider Information | |||||||||
| NPI: | 1356095855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JAMEL | ||||||||
| FirstName: | JUDY | ||||||||
| MiddleName: | ANN MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSWA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PANGBORN | ||||||||
| OtherFirstName: | JUDY | ||||||||
| OtherMiddleName: | ANN MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 115 LIVE OAK CT | ||||||||
| Address2: | |||||||||
| City: | MIDWAY PARK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285441664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525030868 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2801 NEUSE BLVD | ||||||||
| Address2: | |||||||||
| City: | NEW BERN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285622838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2526366007 | ||||||||
| FaxNumber: | 2526720009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2022 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P017251 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.