Provider Demographics
NPI:1265453534
Name:WINGENFELD, PATRICIA MARGARET (MSSA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARGARET
Last Name:WINGENFELD
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2902
Mailing Address - Street 2:
Mailing Address - City:ONECO
Mailing Address - State:FL
Mailing Address - Zip Code:34264-2902
Mailing Address - Country:US
Mailing Address - Phone:941-907-8994
Mailing Address - Fax:941-907-8994
Practice Address - Street 1:6170 STATE ROAD 70 E STE 109
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9721
Practice Address - Country:US
Practice Address - Phone:941-907-8994
Practice Address - Fax:941-782-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00033031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ6795AMedicare ID - Type Unspecified