Provider Demographics
NPI:1538499983
Name:WAKEFIELD, PATRICIA HEFFERNAN (LCSW, LICSW, LMSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:HEFFERNAN
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:LCSW, LICSW, LMSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:HEFFERNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2116
Mailing Address - Country:US
Mailing Address - Phone:267-380-0455
Mailing Address - Fax:
Practice Address - Street 1:75 STATE STREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2116
Practice Address - Country:US
Practice Address - Phone:267-380-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0132871041C0700X
MI68011007201041C0700X
MA1193441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177556TAJMedicare PIN