Healthcare Provider Details

I. General information

NPI: 1629169875
Provider Name (Legal Business Name): PATRICK MCCABE LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEXINGTON ST # 2
FRAMINGHAM MA
01702-8219
US

IV. Provider business mailing address

15 DEMARCO RD
SUDBURY MA
01776-2019
US

V. Phone/Fax

Practice location:
  • Phone: 401-359-0234
  • Fax:
Mailing address:
  • Phone: 401-359-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW01743
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number114552
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: