Provider Demographics
NPI:1114335031
Name:PATAKY, MEGHAN GABRIEL (LCSW)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:GABRIEL
Last Name:PATAKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3595 S TELLER ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2014
Mailing Address - Country:US
Mailing Address - Phone:804-338-6811
Mailing Address - Fax:
Practice Address - Street 1:3595 S TELLER ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2014
Practice Address - Country:US
Practice Address - Phone:804-338-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081303-11041C0700X
COCSW.099249351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical