Provider Demographics
NPI:1043494321
Name:GREGOREK GOODRICH, PATRICE ANNETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:ANNETTE
Last Name:GREGOREK GOODRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1341
Mailing Address - Country:US
Mailing Address - Phone:585-392-9505
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1211
Practice Address - Country:US
Practice Address - Phone:585-392-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-22
Last Update Date:2007-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069273-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical