Provider Demographics
NPI:1093103053
Name:VAN SCYOC, PATRICK
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:VAN SCYOC
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 1:4200 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6210
Mailing Address - Country:US
Mailing Address - Phone:954-749-7230
Mailing Address - Fax:
Practice Address - Street 1:4200 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6210
Practice Address - Country:US
Practice Address - Phone:954-749-7230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker