Healthcare Provider Details

I. General information

NPI: 1720105729
Provider Name (Legal Business Name): PATRICIA MEDEIROS LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N MAIN ST 2ND FLOOR
FALL RIVER MA
02720-2130
US

IV. Provider business mailing address

PO BOX 429
NORTH DIGHTON MA
02764-0429
US

V. Phone/Fax

Practice location:
  • Phone: 781-871-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3559
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: