Provider Demographics
NPI:1043221708
Name:WOLBERD, PATRICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:WOLBERD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 657
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-0657
Mailing Address - Country:US
Mailing Address - Phone:406-223-2002
Mailing Address - Fax:406-294-0967
Practice Address - Street 1:320 N MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2045
Practice Address - Country:US
Practice Address - Phone:406-223-2002
Practice Address - Fax:406-294-0967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT151LCSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0500552Medicaid