=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114184884
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA L GILCHRIST LCSW PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2008
-----------------------------------------------------
Last Update Date | 09/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13294 COMMONWEALTH AVE
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33981-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-276-5096
-----------------------------------------------------
Fax | 941-698-1045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13294 COMMONWEALTH AVE
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33981-4316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-276-5096
-----------------------------------------------------
Fax | 941-698-1045
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA LEE GILCHRIST
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 941-276-5096
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | SW 4404
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------