Healthcare Provider Details

I. General information

NPI: 1831258532
Provider Name (Legal Business Name): VERA JEAN PATTERSON LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 HEALTHWAY DRIVE
BERLIN MD
21811
US

IV. Provider business mailing address

3345 BLUE HERON WAY
EDEN MD
21822
US

V. Phone/Fax

Practice location:
  • Phone: 410-629-0164
  • Fax:
Mailing address:
  • Phone: 410-860-2422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG09010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: