Healthcare Provider Details

I. General information

NPI: 1598996001
Provider Name (Legal Business Name): PATRICIA M HOTHORN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WINNERS CIR N SUITE 120
BRENTWOOD TN
37027-5012
US

IV. Provider business mailing address

915 LAURENS WAY
BRENTWOOD TN
37027-8740
US

V. Phone/Fax

Practice location:
  • Phone: 615-661-5039
  • Fax: 615-376-9278
Mailing address:
  • Phone: 615-661-5039
  • Fax: 615-376-9278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 11605
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSW0000004414
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-008935
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: