Provider Demographics
NPI:1649557380
Name:MEADE, PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MEADE
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 1:6 SURFVIEW WALK
Mailing Address - Street 2:
Mailing Address - City:OCEAN BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11770-2020
Mailing Address - Country:US
Mailing Address - Phone:631-665-6707
Mailing Address - Fax:631-665-3564
Practice Address - Street 1:9 4TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7908
Practice Address - Country:US
Practice Address - Phone:631-665-6707
Practice Address - Fax:631-665-3564
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047192-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR047192-1OtherLICENSE