Provider Demographics
NPI:1417167073
Name:STICKNEY, PATTY S (M A LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:PATTY
Middle Name:S
Last Name:STICKNEY
Suffix:
Gender:F
Credentials:M A LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HARTLEY HILL RD.
Mailing Address - Street 2:P. O. BOX 46
Mailing Address - City:SAXTONS RIVER
Mailing Address - State:VT
Mailing Address - Zip Code:05154
Mailing Address - Country:US
Mailing Address - Phone:802-869-2024
Mailing Address - Fax:
Practice Address - Street 1:2 SHEPARDS LANE
Practice Address - Street 2:
Practice Address - City:SAXTONS RIVER
Practice Address - State:VT
Practice Address - Zip Code:05154
Practice Address - Country:US
Practice Address - Phone:802-869-6668
Practice Address - Fax:802-869-6652
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0680000431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00039805OtherBCBS OF VT
VT1007496Medicare ID - Type Unspecified