Provider Demographics
NPI:1760061303
Name:HOWARD, PATRICK (MA)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HOWARD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 NESCONSET HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1154
Mailing Address - Country:US
Mailing Address - Phone:347-450-1136
Mailing Address - Fax:347-515-6622
Practice Address - Street 1:3771 NESCONSET HWY STE 214
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1154
Practice Address - Country:US
Practice Address - Phone:347-450-1136
Practice Address - Fax:347-515-6622
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-11-01
Deactivation Date:2021-09-09
Deactivation Code:
Reactivation Date:2021-10-28
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
NY110671-01106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program