=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790991743
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA O'KEEFE SEEBERG LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17 RIVER ST
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-1426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-986-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 FOX LN
-----------------------------------------------------
City | WARWICK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10990-2251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-258-1068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 069566-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC05249900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------