Provider Demographics
NPI:1659345866
Name:CLOUGH, PATRICIA MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MARY
Last Name:CLOUGH
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-213-2525
Mailing Address - Fax:540-213-2555
Practice Address - Street 1:79 N MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2344
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2502
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040018061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2011442OtherCIGNA BEHAVIORAL HEALTH
VA010116775Medicaid
VA088038OtherOPTIMA BEHAVIOARL HEALTH
VA147507OtherANTHEM BEHAVIORAL
VA10116775OtherVA PREMIER
VA2284860OtherFIRST HEALTH
VA006257A62Medicare ID - Type Unspecified
VAC03262Medicare PIN
VA010116775Medicaid
VAP00361901Medicare PIN