Provider Demographics
NPI:1487664116
Name:BARRETO, PATRICE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICE
Middle Name:M
Last Name:BARRETO
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:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1005
Mailing Address - Country:US
Mailing Address - Phone:541-963-7289
Mailing Address - Fax:541-963-7289
Practice Address - Street 1:1606 6TH ST
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2520
Practice Address - Country:US
Practice Address - Phone:541-963-7289
Practice Address - Fax:541-962-7289
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35261041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR831399002OtherREGENCE
OR120719Medicare ID - Type Unspecified