Provider Demographics
NPI:1235219684
Name:SEARLES, PATRICIA A (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:SEARLES
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 1:229 TRAVIS TER
Mailing Address - Street 2:
Mailing Address - City:CENTER RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05736-9600
Mailing Address - Country:US
Mailing Address - Phone:802-774-1243
Mailing Address - Fax:
Practice Address - Street 1:88 PARK ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4710
Practice Address - Country:US
Practice Address - Phone:802-775-2395
Practice Address - Fax:802-775-3307
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT08900007551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2113Medicaid
VT00048515OtherBCBS
VTVN2113Medicare ID - Type Unspecified