Provider Demographics
NPI:1598996001
Name:HOTHORN, PATRICIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HOTHORN
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 1:915 LAURENS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8740
Mailing Address - Country:US
Mailing Address - Phone:615-661-5039
Mailing Address - Fax:615-376-9278
Practice Address - Street 1:100 WINNERS CIR N
Practice Address - Street 2:SUITE 120
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5012
Practice Address - Country:US
Practice Address - Phone:615-661-5039
Practice Address - Fax:615-376-9278
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 116051041C0700X
TNLSW00000044141041C0700X
IL149-0089351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514698Medicaid