Provider Demographics
NPI:1376761981
Name:BABCOCK, PATRICIA DIANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANNE
Last Name:BABCOCK
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 1:293 PLANTATION HILL RD
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4861
Mailing Address - Country:US
Mailing Address - Phone:850-525-9295
Mailing Address - Fax:850-934-9188
Practice Address - Street 1:293 PLANTATION HILL RD
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4861
Practice Address - Country:US
Practice Address - Phone:850-525-9295
Practice Address - Fax:850-934-9188
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW68311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical