Provider Demographics
NPI:1205046067
Name:MAILEY, PATRICIA DIBBLE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIBBLE
Last Name:MAILEY
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 1:31 DUNKIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1021
Mailing Address - Country:US
Mailing Address - Phone:215-493-0576
Mailing Address - Fax:
Practice Address - Street 1:31 DUNKIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1021
Practice Address - Country:US
Practice Address - Phone:215-493-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW004130L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical