Provider Demographics
NPI:1629268743
Name:BAXTER, PATRICIA ANN (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:B
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSWR
Mailing Address - Street 1:201 EAST COREEN ST
Mailing Address - Street 2:SUITE 500 ALCOHOL DRUG COUNCIL OF TOMPKINS CO
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-274-6288
Mailing Address - Fax:607-274-6280
Practice Address - Street 1:201 EAST COREEN ST
Practice Address - Street 2:SUITE 500 ALCOHOL DRUG COUNCIL OF TOMPKINS CO
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-274-6288
Practice Address - Fax:607-274-6280
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR026696104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR02291OtherLCSWR