Provider Demographics
NPI:1366672560
Name:PATRICK, CHRISTOPHER IVEY (MSW)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:IVEY
Last Name:PATRICK
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544-1005
Mailing Address - Country:US
Mailing Address - Phone:850-881-4237
Mailing Address - Fax:
Practice Address - Street 1:113 HOWIE WALTERS RD
Practice Address - Street 2:
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544-5668
Practice Address - Country:US
Practice Address - Phone:850-881-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 47961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical