Healthcare Provider Details

I. General information

NPI: 1225192461
Provider Name (Legal Business Name): PATRICK CHIMENTI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

IV. Provider business mailing address

1901 E MAIN ST
RICHMOND IN
47374-5707
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-7284
  • Fax: 765-935-5002
Mailing address:
  • Phone: 765-277-9033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001364A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI0004769
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: