Provider Demographics
NPI:1265654065
Name:PATTISON, MARGERY BOODY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARGERY
Middle Name:BOODY
Last Name:PATTISON
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 1:95 INDIA ST
Mailing Address - Street 2:STE 5
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4250
Mailing Address - Country:US
Mailing Address - Phone:207-775-0155
Mailing Address - Fax:
Practice Address - Street 1:95 INDIA ST
Practice Address - Street 2:STE 5
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4250
Practice Address - Country:US
Practice Address - Phone:207-775-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC5711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMM4609Medicare ID - Type Unspecified