Provider Demographics
NPI:1205230349
Name:PATRICIA TIRONE, LCSW, PLLC
Entity Type:Organization
Organization Name:PATRICIA TIRONE, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLEPROPIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIRONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:239-913-6552
Mailing Address - Street 1:3333 RENAISSANCE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7008
Mailing Address - Country:US
Mailing Address - Phone:239-913-6552
Mailing Address - Fax:239-913-6555
Practice Address - Street 1:3333 RENAISSANCE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7008
Practice Address - Country:US
Practice Address - Phone:239-913-6551
Practice Address - Fax:239-913-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW10864251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7401828OtherVALUEOPTIONS
NY5221329OtherAETNA
NY7401828OtherVALUEOPTIONS
NYN0B371Medicare PIN