Provider Demographics
NPI:1619083649
Name:TIRONE, PATRICIA ELLEN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ELLEN
Last Name:TIRONE
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 1:3333 RENAISSANCE BLVD STE 222
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-7008
Mailing Address - Country:US
Mailing Address - Phone:239-913-6552
Mailing Address - Fax:239-913-6555
Practice Address - Street 1:3333 RENAISSANCE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7008
Practice Address - Country:US
Practice Address - Phone:239-913-6552
Practice Address - Fax:239-913-6555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010108001041C0700X
NYR025511-11041C0700X
FLSW 108641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402828OtherGHI
NY145845OtherVALUE OPTIONS
NYN0B371Medicare ID - Type Unspecified