Provider Demographics
NPI:1174531396
Name:CENTAMORE, PATRICIA (LCSW-R)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CENTAMORE
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 PEARSALL PL
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2114
Mailing Address - Country:US
Mailing Address - Phone:631-667-9102
Mailing Address - Fax:631-854-2552
Practice Address - Street 1:62 PEARSALL PL
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2114
Practice Address - Country:US
Practice Address - Phone:631-667-9102
Practice Address - Fax:631-854-2552
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-0452561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR-045256OtherSOCIAL WORK LICENSE #
NYR-045256OtherSOCIAL WORK LICENSE #