Provider Demographics
NPI:1275635880
Name:PARKER, PAT (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:PAT
Middle Name:
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSWR
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 72
Mailing Address - Street 2:51 MOCCASIN AVENUE
Mailing Address - City:GRAND ISLE
Mailing Address - State:VT
Mailing Address - Zip Code:05458-0072
Mailing Address - Country:US
Mailing Address - Phone:802-372-5748
Mailing Address - Fax:
Practice Address - Street 1:80 SHARRON AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4700
Practice Address - Country:US
Practice Address - Phone:518-561-6247
Practice Address - Fax:518-562-1036
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP063034-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical