Provider Demographics
NPI:1366039836
Name:HALL, PATRICK NORMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:NORMAN
Last Name:HALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530B HARKLE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4739
Mailing Address - Country:US
Mailing Address - Phone:727-403-7847
Mailing Address - Fax:
Practice Address - Street 1:720 E HACIENDA ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2523
Practice Address - Country:US
Practice Address - Phone:727-403-7847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical