Provider Demographics
NPI:1518090380
Name:PRESTRIDGE, PATRICK L (IMFT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:L
Last Name:PRESTRIDGE
Suffix:
Gender:M
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1844
Mailing Address - Country:US
Mailing Address - Phone:330-715-2913
Mailing Address - Fax:
Practice Address - Street 1:3235 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2613
Practice Address - Country:US
Practice Address - Phone:216-406-9217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF.0000010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist