Provider Demographics
NPI:1356315600
Name:PATE, JAE J (LCSW)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:J
Last Name:PATE
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 1:325 MDOS/SGOHSF
Mailing Address - Street 2:
Mailing Address - City:TYNDALL AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32404
Mailing Address - Country:US
Mailing Address - Phone:850-283-7511
Mailing Address - Fax:850-283-7721
Practice Address - Street 1:340 MAGNOLIA CIRCLE
Practice Address - Street 2:325 MDOS/SGOHSF
Practice Address - City:TYNDALL AFB
Practice Address - State:FL
Practice Address - Zip Code:32404
Practice Address - Country:US
Practice Address - Phone:850-283-7511
Practice Address - Fax:850-283-7721
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00023901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical