Provider Demographics
NPI:1588847818
Name:NORDQUIST, PATRICK A (LCSW-R)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:NORDQUIST
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:607-746-2365
Mailing Address - Fax:607-746-8838
Practice Address - Street 1:88 BELL HILL RD
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-3102
Practice Address - Country:US
Practice Address - Phone:607-746-2365
Practice Address - Fax:607-746-8838
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39828104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker