Provider Demographics
NPI:1063846723
Name:DIPASQUALE, PATRICIA RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:RUTH
Last Name:DIPASQUALE
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 1:609B COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3755
Mailing Address - Country:US
Mailing Address - Phone:607-237-7064
Mailing Address - Fax:
Practice Address - Street 1:84 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-2828
Practice Address - Country:US
Practice Address - Phone:607-237-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0802771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical