Healthcare Provider Details

I. General information

NPI: 1578498234
Provider Name (Legal Business Name): PATRICK H BIVONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 NAMSKAKET RD
ORLEANS MA
02653-3202
US

IV. Provider business mailing address

5 NAMSKAKET RD
ORLEANS MA
02653-3202
US

V. Phone/Fax

Practice location:
  • Phone: 774-332-3791
  • Fax:
Mailing address:
  • Phone: 774-332-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCSW230071
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: