Provider Demographics
NPI:1558438853
Name:PATELLA, DENNIS F (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:F
Last Name:PATELLA
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 1:2600 DENALI ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2746
Mailing Address - Country:US
Mailing Address - Phone:907-561-2868
Mailing Address - Fax:907-561-2868
Practice Address - Street 1:2600 DENALI ST
Practice Address - Street 2:SUITE 610
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2746
Practice Address - Country:US
Practice Address - Phone:907-561-2868
Practice Address - Fax:907-561-2868
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK0871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCL3490Medicaid
K150596Medicare ID - Type Unspecified