MEDICARE: PATRICIA DIANNE BABCOCK 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
1	1041C0700X	Clinical Social Worker	SW6831	FL

General Provider Information

NPI Number	:	1376761981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA DIANNE BABCOCK LCSW

Provider Business Mailing Address
First Line	:	293 PLANTATION HILL RD
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4861
Country	:	US
Telephone Number	:	850-525-9295
Fax Number	:	850-934-9188

Provider Business Practice Location Address
First Line	:	293 PLANTATION HILL RD
Second Line	:
City	:	GULF BREEZE
State	:	FL
Zip	:	32561-4861
Country	:	US
Telephone Number	:	850-525-9295
Fax Number	:	850-934-9188

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2007
Last Update Date	:	07/08/2007

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