Healthcare Provider Details

I. General information

NPI: 1912380866
Provider Name (Legal Business Name): PATRICIA DEER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. PATRICIA WITHERS

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ALBOUGH RD
BARKHAMSTED CT
06063-3370
US

IV. Provider business mailing address

22 ALBOUGH RD
BARKHAMSTED CT
06063-3370
US

V. Phone/Fax

Practice location:
  • Phone: 203-770-5883
  • Fax:
Mailing address:
  • Phone: 203-770-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1489
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69580
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: