Provider Demographics
NPI:1609830785
Name:PARKER, PATRICIA A (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12108 N 56TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1686
Mailing Address - Country:US
Mailing Address - Phone:813-985-8100
Mailing Address - Fax:352-518-0063
Practice Address - Street 1:12108 N 56TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1686
Practice Address - Country:US
Practice Address - Phone:813-985-8100
Practice Address - Fax:352-518-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW0002097101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4935Medicare ID - Type UnspecifiedPROVIDER NUMBER