MEDICARE: MS. PATRICIA PERRY PARKER 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	SW5392	FL

General Provider Information

NPI Number	:	1508003724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA PERRY PARKER LCSW

Provider Business Mailing Address
First Line	:	803 E MORENO ST
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32503-5266
Country	:	US
Telephone Number	:	850-435-9696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 W SAINT JOSEPH AVE
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32501-1242
Country	:	US
Telephone Number	:	850-595-6913
Fax Number	:

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

Provider Enumeration Date	:	01/09/2009
Last Update Date	:	01/09/2009

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