Provider Demographics
NPI:1629316583
Name:HALCROW, PATRICIA A (LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:A
Last Name:HALCROW
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1801
Mailing Address - Country:US
Mailing Address - Phone:631-868-0198
Mailing Address - Fax:
Practice Address - Street 1:245 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1801
Practice Address - Country:US
Practice Address - Phone:631-868-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2357101YA0400X
NYR027531-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)