Provider Demographics
NPI:1740219054
Name:NELSON, PATRICIA M (LCSE)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-3608
Mailing Address - Country:US
Mailing Address - Phone:203-655-4693
Mailing Address - Fax:203-655-3452
Practice Address - Street 1:590 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-3608
Practice Address - Country:US
Practice Address - Phone:203-655-4693
Practice Address - Fax:203-655-3452
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0028941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical