Provider Demographics
NPI:1114184884
Name:PATRICIA L GILCHRIST LCSW PA
Entity Type:Organization
Organization Name:PATRICIA L GILCHRIST LCSW PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:941-276-5096
Mailing Address - Street 1:13294 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33981-4316
Mailing Address - Country:US
Mailing Address - Phone:941-276-5096
Mailing Address - Fax:941-698-1045
Practice Address - Street 1:13294 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33981-4316
Practice Address - Country:US
Practice Address - Phone:941-276-5096
Practice Address - Fax:941-698-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 4404251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677288996Medicaid