Provider Demographics
NPI:1407994221
Name:DEVENDORF, PATRICIA AURORA (MS,LADC,NCGCII)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:AURORA
Last Name:DEVENDORF
Suffix:
Gender:F
Credentials:MS,LADC,NCGCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 QUAKER LN S
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1021
Mailing Address - Country:US
Mailing Address - Phone:860-232-2861
Mailing Address - Fax:
Practice Address - Street 1:645 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2907
Practice Address - Country:US
Practice Address - Phone:860-523-9788
Practice Address - Fax:860-232-5049
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000080101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)