Healthcare Provider Details

I. General information

NPI: 1649557380
Provider Name (Legal Business Name): PATRICIA MEADE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 4TH AVE
BAY SHORE NY
11706-7908
US

IV. Provider business mailing address

6 SURFVIEW WALK
OCEAN BEACH NY
11770-2020
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-6707
  • Fax: 631-665-3564
Mailing address:
  • Phone: 631-665-6707
  • Fax: 631-665-3564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR047192-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: