Provider Demographics
NPI:1356647317
Name:PATRICE, DESIREE (LMHC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:PATRICE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E 14TH ST APT 1G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-3139
Mailing Address - Country:US
Mailing Address - Phone:917-913-2138
Mailing Address - Fax:
Practice Address - Street 1:120 W 31ST ST STE 300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3407
Practice Address - Country:US
Practice Address - Phone:917-768-8837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00057385Medicaid