MEDICARE: MRS. PATRICIA JOY FINKENBERG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C003652	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C003652	OTHER	NC	LCSW

General Provider Information

NPI Number	:	1720090426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATRICIA JOY FINKENBERG LCSW

Provider Business Mailing Address
First Line	:	3262 JOHN BARTRAM PL
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7083
Country	:	US
Telephone Number	:	843-856-4143
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 W HILL BLVD
Second Line	:	437 MDOS/SGOH
City	:	CHARLESTON AFB
State	:	SC
Zip	:	29404-4704
Country	:	US
Telephone Number	:	843-963-6972
Fax Number	:	843-963-6501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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