Provider Demographics
NPI:1679559017
Name:WAITE, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:WAITE
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 1:216 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:NORRIDGEWOCK
Mailing Address - State:ME
Mailing Address - Zip Code:04957
Mailing Address - Country:US
Mailing Address - Phone:207-612-8444
Mailing Address - Fax:
Practice Address - Street 1:216 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:NORRIDGEWOCK
Practice Address - State:ME
Practice Address - Zip Code:04957
Practice Address - Country:US
Practice Address - Phone:207-634-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC108631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical