Provider Demographics
NPI:1508880584
Name:KOVACK, PATRICIA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARIE
Last Name:KOVACK
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 1:10000 BAY PINES BLVD.
Mailing Address - Street 2:116D
Mailing Address - City:BAY PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33774
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-398-9509
Practice Address - Street 1:10000 BAY PINES BLVD.
Practice Address - Street 2:116D
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33774
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-398-9509
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW33481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical