Healthcare Provider Details

I. General information

NPI: 1982115747
Provider Name (Legal Business Name): PATRICK DAVIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MAIN ST
WEST HAVEN CT
06516-4296
US

IV. Provider business mailing address

339 MIDLAND AVE
RYE NY
10580-3832
US

V. Phone/Fax

Practice location:
  • Phone: 203-931-1184
  • Fax:
Mailing address:
  • Phone: 917-864-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002969
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: