Provider Demographics
NPI:1508152588
Name:WOOD, PATRICIA ANN (LCSW NEW YORK STATE)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:WOOD
Suffix:
Gender:F
Credentials:LCSW NEW YORK STATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MID-STATE LANE
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-1705
Mailing Address - Country:US
Mailing Address - Phone:518-732-2868
Mailing Address - Fax:
Practice Address - Street 1:1216 MAPLE HILL ROAD
Practice Address - Street 2:MAPLE HILL HIGH SCHOOL
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033
Practice Address - Country:US
Practice Address - Phone:518-732-7701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072194-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY072194-1OtherLICENSED CLINICAL SOCIAL WORKER