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NPI Code Detail

MEDICARE: LARRY M. PATRICK LICSW

MEDICARE: LARRY M. PATRICK LICSW
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 WorkerDP00454215WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1Y340644OTHERWVHEALTH PLAN ID NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3001718253OTHERWVMSBCBS
42070074OTHERWVCIGNA ID NUMBER
5023533000OTHERWVMAGELLAN MIS NUMBER

General Provider Information

NPI Number : 1518026780
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY M. PATRICK LICSW
Provider Business Mailing Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number : 304-723-0665
Provider Business Practice Location Address
First Line : 501 COLLIERS WAY
Second Line :
City : WEIRTON
State : WV
Zip : 26062-5003
Country : US
Telephone Number : 304-723-5440
Fax Number : 304-723-0665
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 05/26/2010

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Directions to “ LARRY M. PATRICK LICSW” Practice Location

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