Provider Demographics
NPI:1659444313
Name:DECHELLO, PATRICK LOUIS (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LOUIS
Last Name:DECHELLO
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:476 MAIN STREET,
Mailing Address - Street 2:P.O. BOX 178,
Mailing Address - City:MIDDLEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06455-1223
Mailing Address - Country:US
Mailing Address - Phone:860-349-8244
Mailing Address - Fax:860-349-5663
Practice Address - Street 1:476 MAIN STREET,
Practice Address - Street 2:SUITE 2, 2ND FLOOR,
Practice Address - City:MIDDLEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06455-1223
Practice Address - Country:US
Practice Address - Phone:860-349-8244
Practice Address - Fax:860-349-5663
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00011431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCO1722Medicare ID - Type Unspecified