Provider Demographics
NPI:1023542982
Name:SEARS, PSY.D., PATRICK
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:SEARS, PSY.D.
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FEDERAL BUREAU OF PRISONS, 100 U.S. HIGHWAY 40
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-2455
Mailing Address - Country:US
Mailing Address - Phone:618-664-6200
Mailing Address - Fax:
Practice Address - Street 1:100 US HIGHWAY 40
Practice Address - Street 2:FCI GREENVILLE, FEDERAL BUREAU OF PRISONS
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246
Practice Address - Country:US
Practice Address - Phone:618-531-6397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016042040103T00000X
IL071009472103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist