Provider Demographics
NPI:1497719439
Name:BOFFARDI, PAT B (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAT
Middle Name:B
Last Name:BOFFARDI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 ROUTE 32
Mailing Address - Street 2:POB 656
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5133
Mailing Address - Country:US
Mailing Address - Phone:845-928-7979
Mailing Address - Fax:845-928-3685
Practice Address - Street 1:509 ROUTE 32
Practice Address - Street 2:POB 656
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-5133
Practice Address - Country:US
Practice Address - Phone:845-928-7979
Practice Address - Fax:845-928-3685
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0595541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923711Medicaid
NYN5G721Medicare ID - Type Unspecified