MEDICARE: DOMINIQUE PATTON 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	SW21702	FL

General Provider Information

NPI Number	:	1932886595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOMINIQUE PATTON LCSW

Provider Business Mailing Address
First Line	:	2762 NW 194TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-2545
Country	:	US
Telephone Number	:	305-780-9359
Fax Number	:

Provider Business Practice Location Address
First Line	:	2762 NW 194TH TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33056-2545
Country	:	US
Telephone Number	:	305-780-9359
Fax Number	:

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

Provider Enumeration Date	:	07/05/2023
Last Update Date	:	07/05/2023

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Directions to “ DOMINIQUE PATTON LCSW” Practice Location

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