Healthcare Provider Details

I. General information

NPI: 1366039836
Provider Name (Legal Business Name): PATRICK NORMAN HALL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SANTO NINO RD
EL PRADO NM
87529-6015
US

IV. Provider business mailing address

RODOVIA FRANCISCO THOMAZ DOS SANTOS 8650 CASA 09
PANTANO DO SUL SANTA CATARINA
88067000
BR

V. Phone/Fax

Practice location:
  • Phone: 505-397-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2024-0722
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: