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NPI Code Detail

MEDICARE: MS. PATRICIA ANN NORTHCUTT LCSW

MEDICARE: MS. PATRICIA ANN NORTHCUTT LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1215060942
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA ANN NORTHCUTT LCSW
Provider Business Mailing Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number : 618-877-9250
Provider Business Practice Location Address
First Line : 50 NORTHGATE INDUSTRIAL DR
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-6805
Country : US
Telephone Number : 618-877-4420
Fax Number : 618-877-9250
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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Directions to “ MS. PATRICIA ANN NORTHCUTT LCSW” Practice Location

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