Provider Demographics
NPI:1609978543
Name:BOERSMA, PATRICIA SPEARS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:SPEARS
Last Name:BOERSMA
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 1:500 GOLD HAWK LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6561
Mailing Address - Country:US
Mailing Address - Phone:817-285-0333
Mailing Address - Fax:817-228-0334
Practice Address - Street 1:500 GOLD HAWK LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6561
Practice Address - Country:US
Practice Address - Phone:817-285-0333
Practice Address - Fax:817-285-0334
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513701041C0700X
FLSW7227104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z7160AOtherMEDICARE UNSPECIFIED