Healthcare Provider Details

I. General information

NPI: 1558173419
Provider Name (Legal Business Name): PATRICK FRANCILIEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 09/11/2025
Certification Date: 01/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 45TH ST S STE 318
FARGO ND
58103-6511
US

IV. Provider business mailing address

6537 PARNELL AVE
DUNDALK MD
21222-4006
US

V. Phone/Fax

Practice location:
  • Phone: 410-908-6385
  • Fax:
Mailing address:
  • Phone: 410-308-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1234
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: